An evaluation of a potential calcium channel blocker-lower-extremity edema-loop diuretic prescribing cascade

Journal of the American Pharmacists Association : JAPhA
Scott Martin VouriMario Schootman

Abstract

Dihydropyridine calcium channel blockers (DH-CCB) are associated with lower-extremity edema (LEE). Loop diuretics have been used inappropriately to treat DH-CCB-associated LEE, constituting a prescribing cascade (PC). The aim of this work was to identify the prevalence and factors associated with potential DH-CCB-LEE-loop diuretic PC. The 2014 National Ambulatory Medical Care Survey was used to identify patient visits in which a DH-CCB was continued. The definition of a potential PC was the continuation or initiation of a loop diuretic in the absence of congestive heart failure, cancer, obstructive sleep apnea, chronic kidney disease or end-stage renal disease, obesity, or resistant hypertension. Multivariable logistic regression was used to identify factors related to a potential PC, including demographic information, number of medications, number of patient visits in the previous 12 months, and comorbid conditions. Among the estimated 47.5 million patient visits in which a DH-CCB was continued, 4.6% had a potential PC. Visits in patients 65 to 84 years of age (odds ratio [OR] 2.56, 95% CI 1.20-5.43) and 85 years of age and older (OR 3.89, 95% CI 1.76-8.61) were more likely to have potential PC compared with patients 18 to 64 ...Continue Reading

Citations

Oct 19, 2019·Journal of the American Geriatrics Society·Scott Martin VouriTodd Manini
Jan 13, 2021·Journal of the American Geriatrics Society·Sonal SinghJerry H Gurwitz
May 10, 2021·BMC Geriatrics·Shanna C TrenamanMelissa K Andrew
Jul 30, 2021·Journal of the American Medical Directors Association·Yu ChenLiang-Kung Chen
Aug 12, 2021·Research in Social & Administrative Pharmacy : RSAP·Earl J MorrisScott M Vouri

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