Doctors often adopt a “don’t mess with success” approach when treating hypertension or type 2 diabetes.
Going by the Numbers:
What is meant by that, though, is a numbers game. If intensive drug treatment gets blood sugar or blood pressure to a pre-defined target number, health professionals often believe they have accomplished something good for the patient. Many don’t appear to be aware of the potential harms of overtreatment of either elevated blood sugar or high blood pressure. There are also questions of whether prescribers recognize that older patients are more vulnerable to the consequences of too much medicine.
Prescribers Don’t Often Reduce Meds or Doses:
A study of more than 200,000 older patients treated through the US Veterans Health Administration in 2012 found that it was fairly uncommon for health care providers to reduce the doses of blood pressure or diabetes medication, even in those whose treatment had resulted in low blood sugar or blood pressure.
Hypertension Treatment:
About 38 percent of those treated for hypertension had very low blood pressure, under 120/65, as a result of their treatment. In the course of the year, only about 19 percent of these patients had their medications adjusted to be less intense.
Diabetes Treatment:
Those patients with low levels of HbA1c, a measure of blood sugar over time, fared a little better: 27 percent of them underwent an adjustment of medication.
JAMA Internal Medicine, online Oct. 26, 2015
The Dangers of Overtreatment:
This shows, however, that it is difficult for doctors to consider backing off on medicines, even if the treatment may be too aggressive. The same research team surveyed primary-care health care professionals in the system to see what they thought about overtreatment.
Hypoglycemia:
The results were not encouraging. Although the ACCORD clinical trial has shown that hypoglycemia (an episode of very low blood sugar) is dangerous and that it can result from aggressive treatment for blood sugar control, 38 percent of these prescribers thought that a hypothetical 77-year-old patient at risk for hypoglycemia should be treated to get his HbA1c under 7%.
Nearly 45 percent of the providers surveyed said they were not worried about consequences of “tight control,” which is doctor-speak for keeping blood sugar low. That is despite the fact that a serious episode of hypoglycemia can land a patient in the hospital and result in brain damage or even death.
JAMA Internal Medicine, online Oct. 26, 2015
Hypotension:
The consequences of overtreatment of hypertension can also be serious. Too much medication can lead to dizziness, falls and possibly fractures. In addition, older people who are overmedicated for high blood pressure are at elevated risk for developing dementia.
We find it discouraging that many of the providers who were not concerned about prescribing too much medicine to control blood sugar worried about not meeting practice guidelines or thought that adjusting the dose of the medication could put them at risk for malpractice claims. Perhaps it is time for health care providers to pay more attention to the risks of overtreatment, especially among elderly patients who could suffer harm from too many medicines.
