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Abstract

This dissertation develops the concept of treatment intensity of asymptomatic conditions (such as hypertension) by examining the potential link between drug treatment for asymptomatic conditions and polypharmacy. Research addressing overtreatment has typically focused on reducing either the total number of medications or identification of potentially inappropriate medications. Multi-morbidity, including both symptomatic, e.g. arthritis, and asymptomatic conditions, e.g. hypertension, increases with age and may be an important driver of increased polypharmacy. Hypothesis #1: There is an association between treatment intensity of hypertension and general polypharmacy. Treatment of hypertension has shown that it can reduce the risk of morbidity and mortality in studied populations. However, the evidence for benefit of treatment in people ≥70 years old has not been consistent. To explore how hypertension is treated and the possible relationship to polypharmacy, I designed two cross sectional studies: a cohort of 214 nursing home patients where I found that patients with treated systolic blood pressure (SBP)