Data from: Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada

Objectives: Describe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (over treatment) and polypharmacy.
Design: Cross sectional study.
Setting: 6 nursing homes in British Columbia, Canada.
Participants: 214 patients, residing in one of selected facilities during data collection period.
Primary and secondary outcome measures: Polypharmacy was defined as >=9 regular medications. Over treatment of diabetes was defined as being prescribed at least one hypoglycemic medication and a glycosylated hemoglobin (A1c) <=7.5%. Over treatment of hypertension required being prescribed at least one hypertension medication and having a systolic blood pressure (SBP) <=128 mmHg. Polypharmacy prescribing, independent of over treatment, was calculated by subtracting disease specific medications from total medications prescribed.
Results: Data gathering was completed for 214 patients, 104 (48%) of whom were prescribed >=9 medications. All patients were very frail. Patients with polypharmacy were more likely to have a diagnosis of hypertension (p=.04) or congestive heart failure (p=.003) and less likely to have a diagnosis of dementia (p=.03). Patients with over treated hypertension were more likely to also experience polypharmacy (RR 1.77 (1.07-2.96), p=.027). Patients with over treated diabetes were prescribed more non-diabetic medications than those with a higher A1c (11.0 ±3.7 versus 7.2 ±3.1, p=.01).
Conclusion: Over treated diabetes and hypertension may be quite prevalent in nursing home patients and the presence of polypharmacy is associated with more aggressive disease treatment. Further study of interventions designed to reduce over treatment of hypertension and diabetes is needed to fully understand the potential links between polypharmacy and potential of harms of disease-specific over treatment.

研究目标：阐明在糖尿病与高血压处方场景下养老院患者的多重用药（polypharmacy）流行情况，并明确经治疗的高血压与糖尿病的较低替代标志物（即过度治疗）与多重用药之间的潜在关联。
研究设计：横断面研究。
研究场景：加拿大不列颠哥伦比亚省的6家养老院。
研究对象：数据收集期间入住所选机构的214名住院患者。
主要及次要结局指标：将多重用药定义为规律服用≥9种常规药物。糖尿病过度治疗定义为：处方至少1种降糖药物且糖化血红蛋白（glycosylated hemoglobin, A1c）≤7.5%。高血压过度治疗定义为：处方至少1种降压药物且收缩压（systolic blood pressure, SBP）≤128 mmHg。独立于过度治疗状态的多重用药处方情况，通过从总处方药物中减去疾病特异性用药后计算得出。
研究结果：共完成214名患者的数据收集，其中104名（48%）患者规律服用≥9种药物。所有研究对象均为重度衰弱人群。存在多重用药的患者更易被诊断为高血压（p=0.04）或充血性心力衰竭（p=0.003），而更不易被诊断为痴呆（p=0.03）。存在高血压过度治疗的患者更易出现多重用药（相对风险RR=1.77，95%置信区间1.07~2.96，p=0.027）。糖尿病过度治疗患者的非糖尿病类处方药物数量多于糖化血红蛋白水平较高的患者（11.0±3.7 vs 7.2±3.1，p=0.01）。
研究结论：养老院患者中糖尿病与高血压的过度治疗现象或较为普遍，多重用药与更积极的疾病治疗方案存在关联。未来需开展针对减少高血压与糖尿病过度治疗的干预研究，以充分阐明多重用药与疾病特异性过度治疗相关危害之间的潜在关联。