Wei Song1,2, Orna Intrator1,2, Sei Lee3, Kenneth Boockvar4,5. 1. VA Central Office Geriatrics & Extended Care, Data & Analysis Center (GECDAC), Washington, DC. 2. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY. 3. San Francisco VA Health Care System and University of California, San Francisco, CA. 4. James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, Bronx, NY. 5. The New Jewish Home Research Institute on Aging, Bronx, NY.
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. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
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. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
Entities:
Keywords:
Hypertension; drug deintensification; fall prevention; long-term care
Authors: Nathalie van der Velde; Bruno H Ch Stricker; Huib A P Pols; Tischa J M van der Cammen Journal: Br J Clin Pharmacol Date: 2006-08-30 Impact factor: 4.335
Authors: Susan L Mitchell; Joan M Teno; Dan K Kiely; Michele L Shaffer; Richard N Jones; Holly G Prigerson; Ladislav Volicer; Jane L Givens; Mary Beth Hamel Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: Hans Wouters; Jessica Scheper; Hedi Koning; Chris Brouwer; Jos W Twisk; Helene van der Meer; Froukje Boersma; Sytse U Zuidema; Katja Taxis Journal: Ann Intern Med Date: 2017-10-10 Impact factor: 25.391
Authors: Michelle C Odden; Sei J Lee; Michael A Steinman; Anna D Rubinsky; Laura Graham; Bocheng Jing; Kathy Fung; Zachary A Marcum; Carmen A Peralta Journal: J Am Med Dir Assoc Date: 2021-08-06 Impact factor: 4.669
Authors: Michelle Vu; Florentina E Sileanu; Sherrie L Aspinall; Joshua D Niznik; Sydney P Springer; Maria K Mor; Xinhua Zhao; Mary Ersek; Joseph T Hanlon; Walid F Gellad; Loren J Schleiden; Joshua M Thorpe; Carolyn T Thorpe Journal: J Am Med Dir Assoc Date: 2020-07-25 Impact factor: 4.669
Authors: Lillian Min; Jin-Kyung Ha; Timothy P Hofer; Jeremy Sussman; Kenneth Langa; William C Cushman; Mary Tinetti; Hyungjin Myra Kim; Matthew L Maciejewski; Leah Gillon; Angela Larkin; Chiao-Li Chan; Eve Kerr Journal: JAMA Netw Open Date: 2020-07-01
Authors: Kenneth S Boockvar; Kimberly M Judon; Joseph P Eimicke; Jeanne A Teresi; Sharon K Inouye Journal: J Am Geriatr Soc Date: 2020-07-25 Impact factor: 7.538
Authors: Carole E Aubert; Jin-Kyung Ha; Hyungjin Myra Kim; Nicolas Rodondi; Eve A Kerr; Timothy P Hofer; Lillian Min Journal: J Am Geriatr Soc Date: 2021-06-07 Impact factor: 5.562