Table 2.
Prevalence of PIP among elderly patients with hypertension or diabetes with hypertension in primary care using STOPP criteria version 1
| STOPP criteria (applicable) | Clinical concerns [8, 25] | PIP in patients with hypertension | PIP in patients with diabetic hypertension | PIP in all patients | PIP by family physician | PIP by general practitioner | p value |
|---|---|---|---|---|---|---|---|
| Cardiovascular system | |||||||
| Long-term digoxin >125 µg/day | increased risk of toxicity | 3 (0.29) | 0 (0) | 3 (0.14) | 2 (0.13) | 0 (0) | 1.0 |
| Furosemide monotherapy for hypertensionb | better alternatives are available | 0 (0) | 4 (0.37) | 4 (0.19) | 2 (0.13) | 2 (0.38) | 0.27 |
| β-blocker in combination with verapamil | increased risk of heart block | 1 (0.09) | 0 (0) | 1 (0.05) | 1 (0.06) | 0 (0) | 1.0 |
| β-blocker in patients with COPD | risk of bronchospasm | 10 (0.98) | 6 (0.56) | 16 (0.77) | 13 (0.88) | 3 (0.58) | 0.77 |
| Vasodilators | risk of syncope, falls | 11 (1.08) | 16 (1.49) | 27 (1.29) | 16 (1.08) | 4 (0.77) | 0.79 |
| Dipyridamole as monotherapy for cardiovascular secondary prevention | no evidence of efficacy | 1 (0.09) | 4 (0.37) | 5 (0.24) | 4 (0.27) | 0 (0) | 0.57 |
| Central nervous system | |||||||
| Chlordiazepoxide for >1 monthc | sedation, confusion, falls, constipation | 19 (1.87) | 25 (2.33) | 44 (2.11) | 30 (2.03) | 14 (2.70) | 0.38 |
| First-generation antihistamine for >1 weekc | risk of sedation and anticholinergic side effects | 6 (0.59) | 4 (0.37) | 10 (0.48) | 7 (0.47) | 3 (0.58) | 0.72 |
| Skeletal muscle relaxants (orphenadrine)c | risk of sedation and anticholinergic side effects | 92 (9.05) | 82 (7.64) | 174 (8.33) | 135 (9.14) | 30 (5.80) | 0.02a |
| Endocrine system | |||||||
| Glyburide in type 2 diabetes mellitus | prolonged hypoglycemia | – | 48 (2.29) | 48 (2.29) | 38 (2.57) | 9 (1.74) | 0.31 |
| Gastrointestinal system | |||||||
| PPI at the full therapeutic dose for >8 weeksc | increased bone fractures, hyponatremia, hypomagnesaemia | 60 (5.90) | 75 (7.00) | 135 (6.46) | 101 (6.84) | 26 (5.03) | 0.17 |
| Anticholinergic antispasmodic drugsc | sedation, confusion, falls, constipation | 13 (1.28) | 14 (1.30) | 27 (1.29) | 22 (1.49) | 3 (0.58) | 0.16 |
| Loperamide for diarrhea of unknown etiologyc | delayed diagnosis | 0 (0) | 1 (0.09) | 1 (0.05) | 0 (0) | 1 (0.19) | 1.0 |
| Musculoskeletal system | |||||||
| Long-term NSAID for >3 monthsc | risk of peptic ulcer | 72 (7.08) | 78 (7.27) | 150 (7.18) | 99 (6.7) | 45 (8.7) | 0.13 |
| Long-term corticosteroids for >3 months | risk of side effects | 3 (0.29) | 1 (0.09) | 4 (0.19) | 4 (0.27) | 0 (0) | 0.57 |
| NSAID with heart failure | exacerbation of heart failure | 2 (0.20) | 0 (0) | 2 (0.10) | 2 (0.13) | 0 (0) | 1.0 |
| Respiratory system | |||||||
| Theophylline monotherapy for COPD | risk of adverse effects | 2 (0.20) | 0 (0) | 2 (0.10) | 2 (0.13) | 0 (0) | 1.0 |
| Therapy duplication | |||||||
| Two β-blockers | risk of adverse effects | 1 (0.09) | 0 (0) | 1 (0.05) | 0 (0) | 1 (0.19) | 1.0 |
| Two calcium channel blockers | risk of adverse effects | 2 (0.20) | 0 (0) | 2 (0.10) | 2 (0.13) | 0 (0) | 1.0 |
| Two diuretics | risk of adverse effects | 9 (0.88) | 26 (2.42) | 35 (1.67) | 23 (1.56) | 12 (2.32) | 0.24 |
| Two RAAS inhibitors | risk of adverse effects | 1 (0.09) | 15 (1.40) | 16 (0.77) | 8 (0.54) | 8 (1.55) | 0.04a |
| Two NSAID | risk of adverse effects | 4 (0.39) | 1 (0.09) | 5 (0.24) | 3 (0.20) | 1 (0.19) | 1.0 |
| Total | 312 (30.64) | 400 (35.08) | 712 (34.09) | 514 (34.75) | 162 (31.3) | 0.16 | |
Values are presented as numbers (%). STOPP, Screening Tool of Older Person's Prescription; COPD, chronic obstructive pulmonary disease; NSAID, nonsteroidal anti-inflammatory drugs; PIP, potentially inappropriate prescribing; PPI, proton pump inhibitor; RAAS, renin-angiotensin-aldosterone system.
a
p < 0.05.
b
Can be used for both acute and chronic clinical conditions.
c
Drugs suggested for acute medical illness.