Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents.
Xiaojuan Liu, Bocheng Jing, Laura A Graham and 8 others
PMID 38950584WHAT IT FOUND
Most long-term care residents had antihypertensive medication changes within six months of admission.
Deprescribing was triggered by low blood pressure, falls, and weight loss, while intensification followed high blood pressure or cardiac events. Frequent changes marked complex health but did not prove benefit.
Key findings
0168% of residents experienced at least one antihypertensive medication change event within 180 days of admission.
02Incident low blood pressure, weight loss, acute renal failure, and falls were associated with higher odds of deprescribing, whereas high blood pressure and cardiovascular events were associated with intensification.
03Residents with multiple medication changes had better functional status, but those with no antihypertensive use had the highest mortality rate.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study population consisted exclusively of VA nursing home residents, who were predominantly male and may not represent the broader long-term care population. The design was observational, so it identifies associations between clinical events and medication changes but cannot prove that the changes caused the outcomes or that they were clinically beneficial. Researchers could not distinguish between intentional, guideline-driven medication changes and random prescriber variation. The analysis did not separate antihypertensives prescribed for other conditions, such as beta-blockers for atrial fibrillation or diuretics for heart failure, which may confound the reasons for medication changes.
Declared interests
The study was supported by the Department of Veterans Affairs and the National Institute on Aging. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the association between medication changes and mortality as evidence that deprescribing or intensification improves survival. The study is descriptive and shows that clinicians adjusted medications in response to clinical status, but it did not test whether these changes led to better patient outcomes.