by Phyllis Hanlon, Contributing Writer
In 2016, the Population Reference Bureau released a report that projects the number of people age 65 and older will more than double from 46 million currently to over 98 million by 2060. Age can bring many changes in health and physical conditions. According to the National Council on Aging (NCOA), about 80 percent of adults over the age of 65 have at least one chronic medical condition such as systemic hypertension, high cholesterol, arthritis, diabetes, heart or kidney disease, depression, Alzheimer’s or chronic obstructive pulmonary disease (COPD).
Given the changes in health people experience as they age, researchers from Texas Tech University Health Sciences Center, Division of Pulmonary and Critical Care Medicine looked to better understand how best to evaluate and manage older patients who are diagnosed with pulmonary hypertension (PH), or high blood pressure in the lungs.
This research team looked at the records of patients who were seen by a PH program between May 2013 and September 2015. This included patients with all types of PH. The researchers ultimately reviewed 97 patients over the age of 60. They collected information on patient characteristics, World Health Organization (WHO) Group, WHO Functional Classification (FC), outcomes after short-term treatment, response to targeted PH drugs, comorbid illnesses, and results from various lab tests, x-rays and scans.
Hawa Edriss, MD led the study, which found that systemic hypertension, or high blood pressure throughout the arteries in the body, was the most frequent comorbid condition in these patients (56.7 percent). The authors also reported that other comorbid cardiovascular-related diseases included coronary artery disease (CAD) (28.8 percent); COPD/asthma (24.7 percent); obstructive sleep apnea (OSA) (24.7 percent); atrial arrhythmias (abnormal heartbeat) (24.7 percent); and congestive heart failure (CHF) (15 percent).
After reviewing WHO Groups, the authors found patients fell into all five classifications: WHO Group 1 = 21; WHO Group 2 = 35; WHO Group 3 = 16; WHO Group 4 = 6; WHO Group 5 = 1. Eighteen patients had a mix of Group 2 and 3. Patients who had WHO Group 1 PH (PAH, pulmonary arterial hypertension) were a minority of the patients seen by the PH program (22%), and were treated with the FDA-approved PH specific drugs. Records revealed that eight of these patients (38%) received monotherapy (one drug) and 13 (62%) received a combination of drugs; all medications were assigned according to the patient’s WHO Group and functional class. In addition to drug therapy, all patients routinely visited the clinic to have their blood pressure monitored and to receive diuretics (water pills) or Continuous Positive Airway Pressure (CPAP) treatment, oxygen and pulmonary rehabilitation when necessary.
While most patients showed improvements or no worsening of their symptoms following drug therapy, the authors cautioned that managing PH appropriately with drugs can be challenging. Clinicians must pay attention to safety and drug interactions with other medications patients might be taking, especially since taking multiple medications is common in older patients. They noted that in addition to a patient’s PH status clinicians should also be aware of the prognosis related to other comorbid illnesses.
For example, the authors explained that prostacyclins (e.g., epoprostenol, iloprost, and treprostinil) could increase the risk for bleeding in patients who are also taking anticoagulants (blood thinners) and/or medication to reduce platelets.
Additionally, phosphodiesterase-5 inhibitors (PDE-5s) (e.g., sildenafil and tadalafil) might increase plasma levels of simvastatin and atorvastatin, which are cholesterol-lowering medications, and elevate the risk of rhabdomyolysis (the destruction of skeletal muscles that can lead to kidney damage).
Bosentan is another PAH drug that should be carefully monitored, according to the authors. They noted that the effect of warfarin (Coumadin) in thinning a patient’s blood might be decerased when also taking bosentan. They also recognized that individuals taking bosentan should be monitored for liver problems.
Dr. Edriss and colleagues emphasized that more study is needed to identify the best treatment approaches and ultimately the best outcomes for older patients with PH.
Each PH patient is different. It is essential that you talk to your own doctor about what treatment options are best for you. For more information on finding a doctor or an accredited care center, visit https://www.phassociation.org/PHCareCenters/Patients.