Deprescribing Blood Pressure Treatment in Long-Term Care Residents.
Michelle C Odden, Sei J Lee, Michael A Steinman and 6 others
PMID 34364847WHAT IT FOUND
70.4% of VA nursing home residents on blood pressure medicines had a blood pressure medicine reduced or stopped during stay.
It was common after admission, near death, or a creatinine rise. The study does not show whether this helps or harms.
Key findings
0122,187 of 31,499 residents (70.4%) had at least one antihypertensive deprescribing event during their nursing home stay.
02Deprescribing was most common in the first 4 weeks after admission and the last 4 weeks of life, with rates of 8.1 and 9.0 per 100 person-weeks.
03After a creatinine increase by at least 50%, residents had an estimated 41.7% chance of deprescribing in the next 4 weeks, compared with 11.5% without that event.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The residents were VA nursing home patients, who are mostly male and do not represent all U.S. nursing home residents. Some antihypertensive medicines may have been used for conditions other than blood pressure lowering, such as atrial fibrillation or heart failure, so the study could not tell how much of each medicine was needed for blood pressure. The paper does not show whether reducing blood pressure medicines prevented falls, kidney injury, death, or other events. Deprescribing rates after triggering events could not be estimated for residents who died or were discharged within 4 weeks of the event. Chronic conditions were identified from ICD codes and VA records, which can misclassify conditions and miss care outside the VA. The multivariable model used only 5% of possible person-weeks because many variables were missing, so its results were limited. Blood pressure readings came from routine clinical care, not research measurement, and may have systematic error.
Declared interests
The article lists NIH and U.S. government research support, and no author conflict declaration is given.
The easy way to misread this
Do not read the 70.4% deprescribing rate or the 41.7% chance after a creatinine rise as evidence that reducing blood pressure medicines is safe or beneficial. The study was observational and did not test whether deprescribing changed patient outcomes.