Elayavilli, Ravikumar Komadur

Background: Concerns for side-effects makes the identification of treatment targets of hypertension in the very elderly challenging. We sought to utilize natural language processing (NLP) to evaluate the prevalence of prespecified side-effects in a cohort of very elderly (≥80 years) patients. Methods and Results: We conducted a two-year, cross-sectional study involving 5169 very elderly patients with and without hypertension seen by primary or specialist providers. Hypertension patients had to have a prior hypertension ICD-9 code in the electronic medical records problem list and ≥2 office visits in 2008 and 2009. We used NLP to analyze extracted free text reports from last clinic visits between 2008 and 2009. Of the 10 prespecified side-effects, hypotension, fatigue, and dizziness were the commonest three conditions and hypotension was significantly higher in the HTN patients. Of the 2835 patients with no prior hypertension history and 2334 hypertension patients identified, the prevalence of each prespecified item in both groups were: acute renal failure (0.3% v 0.6%, p=0.13); syncope (2.8% v 2.2%, p = 0.17), dizziness (3.1% v 4.0%, p=0.09), history of fall (1.0% v 0.9%, p=0.65), fatigue (5.4% v 4.5%, p=0.19), femoral neck fracture (0.18% v 0.04%, p=0.16), palpitations (1.2% v 1.5%, p=0.35), hypotension (4.1% v 6.6%, p<0.001), hyperkalemia (1.1% v 1.7%, p=0.04), hypokalemia (0.4% v 0.9%, p=0.01). At least one presumed side-effect was present in 17.5% of all 5169 patients. Among hypertension patients, there was no significant difference in the prevalence of the side-effects among patients with BP above (578) or below 140/90 (1756) except for acute renal failure (1.21% vs 0.40%, p = 0.03). Conclusion: Analysis of free-text outpatient notes using NLP showed that hypotension and potassium abnormalities were significantly more prevalent in very elderly patients with hypertension compared to similarly aged patients with no hypertension history.