LAUSR

Objective: Hypertension (HTN) and heart failure (HF) share a similar basis of pharmacotherapy, while the presence of HF dominates the selection of drugs. The aim of this study was to analyze HF and HTN comorbidity and cardiovascular pharmacotherapy trajectories in centenarians compared to nonagenarian (90–99 years) and octogenarian (80–89 years) individuals. Design and method: This cohort study used quarterly-structured routine data from N = 1,398 German insurants over six years prior to death (n = 398 centenarians were compared with n = 500 nonagenarians and n = 500 octogenarians). Of those, n = 525 individuals were diagnosed with HF before death. Diagnoses of HTN, HF and comorbidities were associated with prescriptions of medications using Generalized Estimation Equations. Results: Across age groups, HF was significantly more prevalent in centenarians compared to octogenarians and nonagenarians. HTN was the most commonly associated comorbidity with HF (OR = 1.52, p < 0.001). Overall, HF treatment changed significantly over time with an increased prescription rate of loop diuretics and a decreased prescription rate of renin-angiotensin-system (RAS) inhibitors. Centenarians were significantly less likely to receive treatment with either RAS inhibitors, loop diuretics or beta blockers compared to nonagenarians and octogenarians. Furthermore, aldosterone inhibitors, If-channel, and neprilysin inhibitors were not routinely used in our sample. Conclusions: Prescriptions rates for corresponding cardiovascular pharmacotherapy are lower in centenarians, while HF prevalence shows a continuous increase with age. Our data highlight the need for further studies considering quality of pharmacotherapy and outcomes in the population of very old patients. Figure. No caption available.