Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 100893243 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1538-9375 (Electronic) Linking ISSN: 15258610 NLM ISO Abbreviation: J Am Med Dir Assoc Subsets: MEDLINE
    • Publication Information:
      Publication: 2005- : [New York?] : Elsevier
      Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins, c2000-
    • Subject Terms:
      Antihypertensive Agents*/therapeutic use ; Nursing Homes* ; Long-Term Care*; Humans ; Male ; Aged ; Female ; Retrospective Studies ; Aged, 80 and over ; United States ; Hypertension/drug therapy ; Deprescriptions ; United States Department of Veterans Affairs
    • Abstract:
      Objectives: Antihypertensive treatment changes are common in long-term care residents, yet data on the frequency and predictors of changes are lacking. We described the patterns of antihypertensive changes and examined the triggering factors.
      Design: Retrospective cohort study.
      Setting and Participants: A total of 24,870 Department of Veterans Affairs (VA) nursing home residents aged ≥65 years with long-term stays (≥180 days) from 2006 to 2019.
      Methods: We obtained data from the VA Corporate Data Warehouse. Based on Bar Code Medication Administration medication data, we defined 2 types of change events in 180 days of admission: deprescribing (reduced number of antihypertensives or dose reduction of ≥30% compared with the previous week and maintained for at least 2 weeks) and intensification (opposite of deprescribing). Mortality was identified within 2 years after admission.
      Results: More than 85% of residents were prescribed antihypertensives and 68% of them experienced ≥1 change event during the first 6 months of the nursing home stay. We categorized residents into 10 distinct patterns: no change (27%), 1 deprescribing (11%), multiple deprescribing (5%), 1 intensification (10%), multiple intensification (7%), 1 deprescribing followed by 1 intensification (3%), 1 intensification followed by 1 deprescribing (4%), 3 changes with mixed events (7%), >3 changes with mixed events (10%), and no antihypertensive use (15%). Treatment changes were more frequent in residents with better physical function and/or cognitive function. Potentially triggering factors differed by the type of antihypertensive change: incident high blood pressure and cardiovascular events were associated with intensification, and low blood pressure, weight loss, and falls were associated with deprescribing. Death occurred in 7881 (32%) residents over 2 years. The highest mortality was for those without antihypertensive medication (incidence = 344/1000 person-years).
      Conclusions and Implications: Patterns of medication changes existing in long-term care residents are complex. Future studies should explore the benefits and harms of these antihypertensive treatment changes.
      Competing Interests: Disclosures M.A.S. and S.J.L. receive honoraria as authors on UpToDate. The other authors declare no conflicts of interest.
      (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. All rights reserved.)
    • References:
      J Geriatr Cardiol. 2018 Apr;15(4):275-283. (PMID: 29915617)
      Am J Hypertens. 2022 Jan 5;35(1):65-72. (PMID: 34505872)
      J Am Med Dir Assoc. 2009 Jan;10(1):56-61. (PMID: 19111854)
      JAMA. 2020 May 26;323(20):2039-2051. (PMID: 32453368)
      J Am Med Dir Assoc. 2021 Dec;22(12):2540-2546.e2. (PMID: 34364847)
      Arch Intern Med. 2012 Dec 10;172(22):1739-44. (PMID: 23165923)
      Health Serv Res. 2018 Dec;53(6):4066-4086. (PMID: 30353536)
      Arch Intern Med. 1998 Nov 23;158(21):2377-85. (PMID: 9827790)
      High Blood Press Cardiovasc Prev. 2017 Mar;24(1):1-11. (PMID: 28181201)
      Circulation. 2018 Oct 23;138(17):e484-e594. (PMID: 30354654)
      J Am Coll Cardiol. 2019 May 28;73(20):2584-2595. (PMID: 31118153)
      J Am Geriatr Soc. 2021 Oct;69(10):2831-2841. (PMID: 34097300)
      Osteoporos Int. 2013 Oct;24(10):2649-57. (PMID: 23612794)
      JAMA Intern Med. 2015 Oct;175(10):1622-30. (PMID: 26301603)
      JAMA. 2016 Jun 28;315(24):2673-82. (PMID: 27195814)
      Med Care. 2017 Sep;55(9):e68-e72. (PMID: 25763665)
      J Am Med Dir Assoc. 2007 Oct;8(8):538-40. (PMID: 17931579)
      J Am Med Dir Assoc. 2021 Jan;22(1):132-140.e5. (PMID: 32723537)
      J Gen Intern Med. 2009 Apr;24(4):499-503. (PMID: 19198958)
      Cleve Clin J Med. 2014 Jul;81(7):427-37. (PMID: 24987044)
      N Engl J Med. 2008 May 1;358(18):1887-98. (PMID: 18378519)
      JAMA Intern Med. 2019 Nov 01;179(11):1528-1536. (PMID: 31424475)
      J Am Geriatr Soc. 2019 Oct;67(10):2058-2064. (PMID: 31328791)
      Circ Cardiovasc Qual Outcomes. 2016 May;9(3):222-9. (PMID: 27166208)
      BMJ. 2021 Feb 10;372:n189. (PMID: 33568342)
      BMC Geriatr. 2023 Aug 4;23(1):469. (PMID: 37542226)
      Curr Hypertens Rep. 2020 Jan 14;22(1):8. (PMID: 31938958)
      J Am Med Dir Assoc. 2011 Jan;12(1):44-9. (PMID: 21194659)
      JAMA Intern Med. 2015 Jun;175(6):989-95. (PMID: 25685919)
      N Engl J Med. 2015 Nov 26;373(22):2103-16. (PMID: 26551272)
    • Grant Information:
      R24 AG064025 United States AG NIA NIH HHS; R01 AG057751 United States AG NIA NIH HHS; P30 AG044281 United States AG NIA NIH HHS; RF1 AG062568 United States AG NIA NIH HHS; K24 AG049057 United States AG NIA NIH HHS
    • Contributed Indexing:
      Keywords: Nursing home; deprescribing; epidemiology; functional status; hypertension
    • Accession Number:
      0 (Antihypertensive Agents)
    • Publication Date:
      Date Created: 20240701 Date Completed: 20240902 Latest Revision: 20240904
    • Publication Date:
      20240904
    • Accession Number:
      PMC11368635
    • Accession Number:
      10.1016/j.jamda.2024.105119
    • Accession Number:
      38950584