Late Deprescribing of Angiotensin-Converting-Enzyme Inhibitors and Renin-Angiotensin Blockers in Patients with Advanced Cancer Receiving Palliative Care

Abstract

Background: Treatment with antihypertensives in patients with advanced cancer is often continued until very late in the disease trajectory, despite a considerable risk of hypotension. Objectives: The aim of this study was to investigate the time of deprescribing of antihypertensive agents in patients with cancer receiving palliative care during their last year of life. The monitoring of blood pressure (BP) during treatment was also studied. Design: Retrospective cohort study. Setting/Subjects: Medical records of all patients admitted during a three-year period to a home care unit in Stockholm, Sweden, and now deceased were screened for antihypertensive agents. To create a homogenous cohort, only agents of the renin-angiotensin system (ATC-code C09) were included. Measurements: Data for time of deprescribing and monitoring of BP were collected. Results: Of 1501 deceased patients, 353 had been treated with agents of the renin-angiotensin system for hypertension and had a primary diagnosis of cancer. BP was measured before deprescribing in 169 patients (47.9%). In 102 patients (28.9%), antihypertensive treatment continued up to the last seven days of life. For 27 patients (7.6%), the treatment had not been deprescribed. In 184 patients (52, 1%), BP was not followed up despite continued antihypertensive treatment. All 27 patients whose treatment was never deprescribed were in this group. Conclusions: This study shows that antihypertensive treatment is often deprescribed late or not at all in patients with advanced cancer. Monitoring BP in patients treated with antihypertensives in palliative care may facilitate making the decision to deprescribe them in time.

Keywords

• antihypertensivs
• deprescribing
• pharmacology