Intensive blood pressure therapy not beneficial in nursing home residents

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.

The researchers found that at baseline, 54.4 percent of long-term nursing home residents received one antihypertensive medication, 34.3 percent received two, and 11.4 percent received three or more. Receipt of fewer antihypertensive medications was associated 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, increased intensity of treatment was associated 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.

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