Intensive Blood Pressure Therapy Not Beneficial In Nursing Home

Long-term nursing home residents with hypertension do not experience significant benefits from more intensive antihypertensive treatment, according to a study published online July 22 in the Journal of the American Geriatrics Society. Kenneth S. Boockvar, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the number of first-line antihypertensive medications in Medicare Part D dispensing data among 255,670 long-term nursing home residents (average age, 84.7 years) treated for hypertension in the second quarter of 2013.

Information from Medicare records

The research team use information from Medicare records. The team identify 255,670 long-term nursing home residents in the United States during 2013 who had high blood pressure. Of these, nearly half had moderate or severe dementia relate difficulties with thinking and decision making. Slightly more than half of them had no or only mild cognitive impairment.

The study’s participants were about 85 years old on average. They had moderate impairment of their physical function; also about 3% were receiving hospice care or had a life expectancy of six months or less. The primary exposure was intensity of antihypertensive treatment; which as define as number of first‐line antihypertensive medications in Medicare Part D dispensing data.

The outcome measures were hospitalization, hospitalization for cardiovascular diseases using Medicare Hierarchical Condition Categories; decline in physical function using the MDS Activities of Daily Living (ADLs) scale, death during a 180‐day follow‐up period. The researchers said that their study’s findings suggest that long-term nursing home residents; so with high blood pressure do not experience significant benefits from more intensive treatment.

Long term nursing home

“Older adults and their caregivers should be aware that intensive treatment; so high blood pressure may not be helpful in long-term nursing home residents. It is reasonable to consider reducing the dose of these drugs or discontinuing their use in residents with dementia, if doing so is consistent with their goals of care.” The researchers found that at baseline, 54.4% of long-term nursing home residents receive one antihypertensive medication, 34.3% receive two, and 11.4% receive three or more.

Receipt of fewer antihypertensive medications was with moderate or severe cognitive impairment(odds ratio, 0.80 versus no or mild impairment), worse physical function (odds ratio, 0.64 worst versus best tertile), and hospice or less than a six-month life expectancy (odds ratio, 0.80). There was no significant difference in mortality per additional antihypertensive medication. However, increase intensity of treatment was with small increases in hospitalization and a small decrease in decline in activities of daily living. ”

Antihypertensive medications are reasonable targets for deintensification in residents in whom this is consistent with goals of care,” the authors write. Long‐term NH residents with hypertension do not experience significant benefits from more intensive antihypertensive treatment. Antihypertensive medications are reasonable targets for deintensification in residents in whom this is consistent with goals of care.