Timothy S Anderson1,2,3, Bocheng Jing2,4, Andrew Auerbach5, Charlie M Wray2,5, Sei Lee2,4, W John Boscardin2,4, Kathy Fung2,4, Sarah Ngo2,4, Molly Silvestrini2,4, Michael A Steinman2,4. 1. Division of General Internal Medicine, University of California, San Francisco. 2. San Francisco Veterans Affairs Medical Center, San Francisco, California. 3. now with Division of General Medicine, Beth Israel Deaconess Medical Center, Brookline, Massachusetts. 4. Division of Geriatrics, University of California, San Francisco. 5. Division of Hospital Medicine, University of California School of Medicine, San Francisco.
Abstract
IMPORTANCE: Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization. OBJECTIVE: To investigate the association between intensification of antihypertensive regimens at hospital discharge and clinical outcomes after discharge. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, patients 65 years and older with hypertension who were hospitalized in Veterans Health Administration national health system facilities from January 1, 2011, to December 31, 2013, for common noncardiac conditions were studied. Data analysis was performed from October 1, 2018, to March 10, 2019. EXPOSURES: Discharge with antihypertensive intensification, defined as receiving a prescription at hospital discharge for a new or higher-dose antihypertensive than was being used before hospitalization. Propensity scores were used to construct a matched-pairs cohort of patients who did and did not receive antihypertensive intensifications at hospital discharge. MAIN OUTCOMES AND MEASURES: The primary outcomes of hospital readmission, serious adverse events, and cardiovascular events were assessed by competing risk analysis. The secondary outcome was the change in systolic BP within 1 year of hospital discharge. RESULTS: The propensity-matched cohort included 4056 hospitalized older adults with hypertension (mean [SD] age, 77 [8] years; 3961 men [97.7%]), equally split between those who did vs did not receive antihypertensive intensifications at hospital discharge. Groups were well matched on all baseline covariates (all standardized mean differences <0.1). Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1.06-1.88; NNH, 63; 95% CI, 34-370). At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, -2.4 to 3.7 mm Hg). CONCLUSIONS AND RELEVANCE: Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.
IMPORTANCE: Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization. OBJECTIVE: To investigate the association between intensification of antihypertensive regimens at hospital discharge and clinical outcomes after discharge. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, patients 65 years and older with hypertension who were hospitalized in Veterans Health Administration national health system facilities from January 1, 2011, to December 31, 2013, for common noncardiac conditions were studied. Data analysis was performed from October 1, 2018, to March 10, 2019. EXPOSURES: Discharge with antihypertensive intensification, defined as receiving a prescription at hospital discharge for a new or higher-dose antihypertensive than was being used before hospitalization. Propensity scores were used to construct a matched-pairs cohort of patients who did and did not receive antihypertensive intensifications at hospital discharge. MAIN OUTCOMES AND MEASURES: The primary outcomes of hospital readmission, serious adverse events, and cardiovascular events were assessed by competing risk analysis. The secondary outcome was the change in systolic BP within 1 year of hospital discharge. RESULTS: The propensity-matched cohort included 4056 hospitalized older adults with hypertension (mean [SD] age, 77 [8] years; 3961 men [97.7%]), equally split between those who did vs did not receive antihypertensive intensifications at hospital discharge. Groups were well matched on all baseline covariates (all standardized mean differences <0.1). Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1.06-1.88; NNH, 63; 95% CI, 34-370). At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, -2.4 to 3.7 mm Hg). CONCLUSIONS AND RELEVANCE: Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.
Authors: Christina M Vitto; Joseph D Lykins V; Hillary Wiles-Lafayette; Taruna K Aurora Journal: Curr Hypertens Rep Date: 2022-05-20 Impact factor: 4.592
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: Lama Ghazi; Fan Li; Xinyuan Chen; Michael Simonov; Yu Yamamoto; Aditya Biswas; Jonathan Hanna; Tayyab Shah; Raymond Townsend; Aldo Peixoto; F Perry Wilson Journal: J Clin Hypertens (Greenwich) Date: 2022-02-17 Impact factor: 2.885
Authors: Timothy S Anderson; Sei Lee; Bocheng Jing; Kathy Fung; Sarah Ngo; Molly Silvestrini; Michael A Steinman Journal: JAMA Netw Open Date: 2020-03-02