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. 2018 Dec;53(6):4066-4086.
doi: 10.1111/1475-6773.13074. Epub 2018 Oct 23.

Antihypertensive Drug Deintensification and Recurrent Falls in Long-Term Care

Wei Song  1   2 , Orna Intrator  1   2 , Sei Lee  3 , Kenneth Boockvar  4   5
Affiliations

Antihypertensive Drug Deintensification and Recurrent Falls in Long-Term Care

Wei Song et al. Health Serv Res. 2018 Dec.

Abstract

Objective: To examine the relationship between antihypertensive drug deintensification and recurrent falls in long-term care.

Data sources/settings: Department of Veterans Affairs (VA) inpatient, outpatient, and purchased care data, Minimum Data Set assessments from VA nursing homes (NHs), and Medicare claims from fiscal years 2010 - 2015.

Study design: We identified NH residents with evidence of overaggressive antihypertensive treatment, defined as systolic blood pressure (SBP) 80-120 and an index fall. Recurrent fall, hospitalization, and mortality within 30 days were compared between veterans whose antihypertensive medications were deintensified versus those whose antihypertensive medications were not using propensity score methods (PSM).

Principal findings: Among 2,212 NH residents with possibly overaggressive antihypertensive treatment, 11 percent experienced antihypertensive drug deintensification. Lower blood pressure, >1 antihypertensive drug, no congestive heart failure, fracture from index fall, and older age were associated with higher likelihood of deintensification. Antihypertensive deintensification was associated with statistically significant (p-value < .01) lower risk of recurrent fall among residents with SBP 80-100 (marginal effect = -11.4 percent; PSM = -13.6 percent) and higher risk of death among residents with SBP 101-120 (marginal effect = 2.1 percent, p-value = .07; with PSM = 4.3 percent, p-value = .04).

Conclusions: Results provide some needed evidence and guidelines for deintensifying antihypertensive medication among frail older residents; since hypertension is prevalent among 54 percent of NH residents, the potential impact of new evidence is great.

Keywords: Hypertension; drug deintensification; fall prevention; long-term care.

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Figures

Figure 1
Figure 1
Factors That Could Influence Antihypertensive Deintensification Decisions
Figure 2
Figure 2
Study Design. The Index Date was the Date of Low Blood Pressure, Followed by a Fall within 3 Days Note. A Treatment Decision Period of 7 Days in Which Deintensification Could Have Occurred Began on the Index Date. An Outcome Period of 30 Days Began at the End of the Treatment Decision Period.
See this image and copyright information in PMC

References

    1. Abt Associates, Inc . 2001. Identification and Evaluation of Existing Quality Indicators that are Appropriate for Use in Long Term Care Settings. Baltimore, MD: Centers for Medicare and Medicaid Services.
    1. AGS . 2015. “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society 63: 2227‐46. - PubMed
    1. Bain, K. T. , Holmes H. M., Beers M. H., Maio V., Handler S. M., and Pauker S. G.. 2008. “Discontinuing Medications: A Novel Approach for Revising the Prescribing Stage of the Medication‐Use Process.” Journal of the American Geriatrics Society 56: 1946‐52. - PMC - PubMed
    1. Beckett, N. S. , Peters R., Fletcher A. E., Staessen J. A., Liu L., Dumitrascu D., Stoyanovsky V., Antikainen R. L., Nikitin Y., Anderson C., Belhani A., Forette F., Rajkumar C., Thijs L., Banya W., Bulpitt C. J., and Study Group Hyvet.. 2008. “Treatment of Hypertension in Patients 80 Years of Age or Older.”New England Journal of Medicine 358: 1887‐98. - PubMed
    1. Benetos, A. , Labat C., Rossignol P., Fay R., Rolland Y., Valbusa F., Salvi P., Zamboni M., Manckoundia P., Hanon O., and Gautier S.. 2015. “‘Treatment with Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study.” JAMA Internal Medicine 175: 989‐95. - PubMed

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