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Less Might Be Better: Deprescribing Antihypertensive Medications in Older Adults

Health care professionals often don’t think twice about adding a new medication when a patient is not at goal. But we’re reluctant to stop a medication for a chronic condition when the patient appears to be stable and doing well.  Polypharmacy in older adults is a significant problem.  It’s costly and increases the likelihood of adverse effects. Several observational studies have suggested that lower blood pressure and multiple antihypertensive medications may be harmful in the elderly. Is it possible to discontinue medications without causing serious harm?

Guest Authors: Keturah Weaver Pharm D, BCPS and Daniel Longyhore Pharm D, M.S., BCACP

Music by Good Talk

If Your Heart’s Not into It, Do You Really Need to Take Your Meds?

Dilated cardiomyopathy is the leading cause of sudden cardiac death and heart failure (HF) and the chief indication for cardiac transplantation. However, approximately 40% of patients see a significant improvement in left ventricular ejection fraction and reduction in the left ventricle size over time with pharmacologic treatment. As deprescribing becomes an increasingly important part of our clinical practice, we need more data about how deprescribing impacts outcomes, particularly in chronic diseases such as heart failure.  The recently published TRED-HF is attempted to address this important question: Is the burden of lifelong therapy with medications necessary or worth it in patients with "recovered" dilated cardiomyopathy?

Guest Author:  Jennifer Pruskowski, PharmD, BCPS, BCGP, CPE

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Know When to Hold ‘Em - Know When to Fold ‘Em. Deprescribing in BPH.

A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).  In more symptomatic patients, or patients with confirmed, enlarged prostates, it is recommended to use both medication classes (alpha-1 blocker and 5-alpha reductase inhibitor) to minimize symptoms by relaxing the prostatic smooth muscle and reducing the size of the prostate – producing a potentially synergistic effect.  This study found that withdrawal of alpha 1-blockers after a year of combination therapy did not worsen urinary symptoms, QOL, and voiding or storage function.  This provides evidence that combination therapy may not be needed indefinitely for all patients.

Guest Authors:  Erica Crannage, PharmD and Stephanie Crist, PharmD

Music by Good Talk

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