Tailoring of cardiovascular medication in older patients

Cardiovascular disease is a leading cause of morbidity and mortality globally, particularly in older adults. Antihypertensive medications significantly reduce these risks but pose challenges in older populations, including side effects, especially in case of overtreatment. This thesis explores tailoring cardiovascular medication in older patients, focusing on responsible deprescribing of antihypertensive and anticoagulant medications.

Firstly, we assessed the prevalence of older patients at risk for adverse events due to antihypertensive medication use in the Netherlands, identifying the proportion potentially eligible for deprescribing. Next, we examined fundamental pharmacokinetic and pharmacodynamic differences in antihypertensive medication between younger and older patients to better understand the increased side effects in older patients.

Additionally, we developed and tested a practical protocol for deprescribing antihypertensives in general practices. Furthermore, we evaluated the efficacy and safety of anticoagulants in older patients with atrial fibrillation, particularly in the last phase of life, when the benefit-risk balance shifts.

This research provides valuable insights and practical guidance for healthcare professionals to better tailor cardiovascular treatments in older patients, ultimately aiming to enhance their health outcomes and quality of life.