Factors associated with antihypertensive treatment intensification and deintensification in older outpatients

doi:10.1016/j.ijchy.2021.100098

. 2021 Jun 23:9:100098.

doi: 10.1016/j.ijchy.2021.100098. eCollection 2021 Jun.

Factors associated with antihypertensive treatment intensification and deintensification in older outpatients

Carole E Aubert^{1

2

3

4}, Jin-Kyung Ha⁵, Eve A Kerr^{3

4

6}, Timothy P Hofer^{3

4

6}, Lillian Min^{3

4

5

7}

Affiliations

¹ Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
² Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
³ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁴ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
⁵ Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁷ VA Ann Arbor Medical Center VA Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI, USA.

PMID: 34258575
PMCID: PMC8254109
DOI: 10.1016/j.ijchy.2021.100098

Factors associated with antihypertensive treatment intensification and deintensification in older outpatients

Carole E Aubert et al. Int J Cardiol Hypertens. 2021.

. 2021 Jun 23:9:100098.

doi: 10.1016/j.ijchy.2021.100098. eCollection 2021 Jun.

Authors

Carole E Aubert^{1

2

3

4}, Jin-Kyung Ha⁵, Eve A Kerr^{3

4

6}, Timothy P Hofer^{3

4

6}, Lillian Min^{3

4

5

7}

Affiliations

¹ Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
² Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
³ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁴ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
⁵ Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
⁷ VA Ann Arbor Medical Center VA Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI, USA.

PMID: 34258575
PMCID: PMC8254109
DOI: 10.1016/j.ijchy.2021.100098

Abstract

Background: New hypertension performance measures encourage more intensive treatment in older adults. Treatment intensification includes starting new medications and increasing the dose of old ones. Medication dose is particularly important to older adults, given their vulnerability to dose-related side effects. We previously validated a standardized measure of beneficial doses tested in hypertension trials, Hypertension Daily Dose (HDD).

Aim of the study: To test whether changes in treatment intensity using HDD was associated with systolic blood pressure (SBP) and patient characteristics.

Methods: Longitudinal study of all Veterans aged ≥65 years with a diagnosis of hypertension. We defined 3 groups of risk: 1) cardiovascular risk; 2) geriatric/frail; 3) low-risk (comparator). Using multinomial regression, we assessed the probability of deintensification, intensification, vs. stable treatment, according to SBP and group.

Results: Among 1,331,111 Veterans, 19.9% had deintensification, and 29.6% intensification. Deintensification decreased, while intensification increased, with SBP. Compared to low-risk patients, cardiovascular risk patients had 1.11 (95% CI 1.10-1.13) times the odds of intensifying, and geriatric/frail patients 1.45 (95%CI 1.43-1.47) times the odds of deintensifying.

Discussion: Patient-level HDD change was consistent with an expected association with cardiovascular risk and geriatric/frail conditions, suggesting that HDD can be used longitudinally to assess hypertension treatment modification in large health systems.

Keywords: Deintensification; Elderly; Hypertension; Intensification; Medication; Patterns; Treatment; Veterans.

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Figures

**Fig. 1**
Distribution of baseline antihypertensive medication regimen, according to baseline blood pressure in all patients (N = 1,331,111): A) dose and SBP; B) dose and DBP; C) medication count and SBP; D) medication count and DBP.

**Fig. 2**
Probability of each treatment strategy according to baseline systolic blood pressure in three subgroups based on comorbidities.

See this image and copyright information in PMC

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Coppola A, Chuquitaype M, Guglielmo S, Pujia R, Ferrulli A, Falcone C, Maurotti S, Montalcini T, Luzi L, Gazzaruso C. Coppola A, et al. Endocrine. 2024 Oct;86(1):127-134. doi: 10.1007/s12020-024-03839-8. Epub 2024 Apr 24. Endocrine. 2024. PMID: 38656749

References

1. Muntner P., Carey R.M., Gidding S. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137:109–118. - PMC - PubMed
1. Self-reported hypertension and use of antihypertensive medication among adults - United States, 2005-2009. MMWR Morb. Mortal. Wkly. Rep. 2013;62:237–244. - PMC - PubMed
1. Onder G., van der Cammen T.J., Petrovic M., Somers A., Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42:284–291. - PubMed
1. Min L., Ha J.K., Hofer T.P. Validation of a health system measure to capture intensive medication treatment of hypertension in the veterans health administration. JAMA Netw Open. 2020;3 - PMC - PubMed
1. Min L., Ha J.K., Aubert C.E. A method to quantify mean hypertension treatment daily dose intensity using health care system data. JAMA Netw Open. 2021;4 - PMC - PubMed

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P30 AG024824/AG/NIA NIH HHS/United States

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[1] Muntner P., Carey R.M., Gidding S. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137:109–118. - PMC - PubMed

[2] Muntner P., Carey R.M., Gidding S. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018;137:109–118. - PMC - PubMed

[3] Self-reported hypertension and use of antihypertensive medication among adults - United States, 2005-2009. MMWR Morb. Mortal. Wkly. Rep. 2013;62:237–244. - PMC - PubMed

[4] Self-reported hypertension and use of antihypertensive medication among adults - United States, 2005-2009. MMWR Morb. Mortal. Wkly. Rep. 2013;62:237–244. - PMC - PubMed

[5] Onder G., van der Cammen T.J., Petrovic M., Somers A., Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42:284–291. - PubMed

[6] Onder G., van der Cammen T.J., Petrovic M., Somers A., Rajkumar C. Strategies to reduce the risk of iatrogenic illness in complex older adults. Age Ageing. 2013;42:284–291. - PubMed

[7] Min L., Ha J.K., Hofer T.P. Validation of a health system measure to capture intensive medication treatment of hypertension in the veterans health administration. JAMA Netw Open. 2020;3 - PMC - PubMed

[8] Min L., Ha J.K., Hofer T.P. Validation of a health system measure to capture intensive medication treatment of hypertension in the veterans health administration. JAMA Netw Open. 2020;3 - PMC - PubMed

[9] Min L., Ha J.K., Aubert C.E. A method to quantify mean hypertension treatment daily dose intensity using health care system data. JAMA Netw Open. 2021;4 - PMC - PubMed

[10] Min L., Ha J.K., Aubert C.E. A method to quantify mean hypertension treatment daily dose intensity using health care system data. JAMA Netw Open. 2021;4 - PMC - PubMed

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Factors associated with antihypertensive treatment intensification and deintensification in older outpatients

Affiliations

Factors associated with antihypertensive treatment intensification and deintensification in older outpatients

Authors

Affiliations

Abstract

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