Newswise — INDIANAPOLIS –
Researchers from Regenstrief Institute and the universities of South Carolina and Indiana conducted a new study, which found that the most frequently prescribed medications for high blood pressure did not protect against developing delirium in the ICU. This was true regardless of the patient's age, gender, race, co-existing health problems, or insurance status, and even if the medications were taken for at least six months before being admitted to the ICU.
Delirium is a condition where there is a sudden change in brain function, and it affects around seven million hospitalized patients in the U.S. every year. It can lead to longer hospital and ICU stays, an increased chance of needing mechanical ventilation, and long-term problems with cognitive function. Delirium can also increase the likelihood of being placed in a nursing home and of dying. As the severity and duration of delirium increase, the chances of having long-term cognitive and functional problems after leaving the hospital also increase.
Dr. Babar Khan, a researcher and clinician at Regenstrief Institute and Indiana University School of Medicine, explained that they investigated the use of ACE inhibitors and angiotensin receptor blockers as potential ways to reduce delirium severity and duration. These medications are known to help stabilize blood pressure and have been thought to have protective effects on the brain. However, their study found that patients who had taken these medications before being admitted to the ICU did not have a lower prevalence of delirium compared to those who had not taken them.
Chronic high blood pressure, which can be successfully lowered by ACE inhibitors and angiotensin receptor blockers, is one of the risk factors for ICU-acquired delirium.
The study analyzed the electronic health records of 4,791 patients of different races and found that taking blood pressure medications like ACE inhibitors and angiotensin receptor blockers for at least six months before admission to an ICU did not provide enough protection or resilience to prevent delirium. This was an observational study, meaning that the researchers did not intervene with the patients' treatment, but rather looked at existing medical records to draw conclusions.
Dr. Khan was also involved in a previous study published in the New England Journal of Medicine in 2018 that investigated whether commonly prescribed antipsychotic drugs could affect the duration of delirium. The study found that these drugs did not have any impact on the duration of delirium.
Dr. Babar Khan and Dr. Sikandar Khan from Regenstrief Institute and IU School of Medicine are working with Mayo Clinic on a study to see if listening to music can help prevent delirium in older adult ICU patients who are on a ventilator. They want to find out if this music intervention can improve their brain health after leaving the ICU.
Dr. Sikandar Khan said that the study of blood pressure medications is a part of their ongoing research to understand the role of vascular risk factors in delirium. They want to know how different biological processes in aging, such as blood pressure and inflammation, work together and lead to delirium, and then possibly to dementia.
“Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis” is published in the Journal of the American Geriatrics Society. The study was funded by the National Institutes of Health’s National Institute of Nursing Research and National Institute on Aging.
Authors and affiliations
Malissa A. Mulkey, PhD, APRN, CCNS, CCRN, CNRN1 (corresponding author); Sikandar Khan, D.O., M.S.2,3,4,5; Anthony Perkins, M.S.3,6; Sujuan Gao, PhD3,6; Sophia Wang, M.D.3,7; Noll Campbell PharmD, MS4,5,8; and Babar Khan, M.D., M.S.2,3,4,5
1 College of Nursing, University of South Carolina, Columbia, South Carolina, USA
2 Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University-Purdue University, Indianapolis, Indiana, USA
3 School of Medicine, Indiana University, Indianapolis, Indiana, USA
4 Center for Aging Research, Indiana University, Indianapolis, Indiana, USA
5 Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
6 Department of Biostatistics and Health Data Science, Indiana University-Purdue University, Indianapolis, Indiana, USA
7 Department of Psychiatry, Department of Biostatistics and Health Data Science, Indianapolis, Indiana, USA
8 Department of Pharmacy Practice, Purdue University, Lafayette, Indiana, USA
Babar Khan, M.D., M.S.
In addition to his appointment as a Regenstrief Institute research scientist and as associate director of the Indiana University Center for Aging at Regenstrief Institute, Babar Khan, M.D., M.S., is an IU School of Medicine professor of medicine and the Floyd and Reba Smith Professor of Respiratory Disease.
Sikandar Khan, D.O., M.S.
In addition to his role as a research scientist and co-director of the COVID-19 recovery program for older adults with the Indiana University Center for Aging Research at Regenstrief Institute, Sikandar Khan, D.O., M.S., is an assistant professor of medicine and director of the Indiana University Health Intensive Care Unit (ICU) Survivor Center.
About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.
Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.
About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.
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