Antihypertensive Deprescribing in Older Adult Veterans at End of Life Admitted to Veteran Affairs Nursing Homes.
Michelle Vu, Florentina E Sileanu, Sherrie L Aspinall and 10 others
PMID 32723537WHAT IT FOUND
Forty-one percent of nursing home residents near end of life with low systolic BP and antihypertensive drugs had deprescribing within 30 days; very low BP on multiple drugs was the strongest associated factor.
Key findings
01Thirty-day cumulative incidence of antihypertensive deprescribing was 41% among residents with limited life expectancy or advanced dementia, systolic BP below 120 mm Hg, and baseline antihypertensive use.
02Very low systolic BP below 100 mm Hg plus multiple antihypertensive classes was the strongest factor associated with deprescribing, with an adjusted hazard ratio of 2.44 compared with low systolic BP plus one class.
03Poor-prognosis markers including recent weight loss, poor appetite, dehydration, ADL dependence, and pain were associated with greater likelihood of deprescribing, while diabetes, CHF, obesity, and shortness of breath were associated with lower likelihood.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not use agreed-on criteria for potential overtreatment of hypertension at end of life, and the authors tested alternative BP and deprescribing time definitions. It did not assess patient or caregiver preferences, whether deprescribing was intentional, or outcomes such as falls, hospitalization, mortality, or cognitive performance. The next-of-kin proximity and relationship findings are hard to interpret because the listed next of kin may not be the primary surrogate decision maker. The sample was mostly male and non-Hispanic white Veterans in VA nursing homes, so it may not represent other nursing home populations. Associations from a retrospective cohort do not establish that any factor caused deprescribing or that deprescribing was clinically appropriate.
Declared interests
No author conflicts of interest or funding declaration is included in the supplied text; the metadata lists NIH and U.S. government non-PHS research support.
The easy way to misread this
Do not read the 41% deprescribing rate as proof that stopping antihypertensives helps or harms residents at end of life. This observational study did not assess patient or caregiver preferences, intentionality, or outcomes, and it used no agreed-on criteria for overtreatment.