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Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care.
Vu M, Schleiden LJ, Harlan ML, Thorpe CT. Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care. Current Hypertension Reports. 2020 Jan 14; 22(1):8.
PURPOSE OF REVIEW:
We sought to summarize recent evidence regarding optimal blood pressure (BP) treatment targets and antihypertensive regimen intensity for nursing home (NH) residents and similar older, complex patients with hypertension.
Recent trials have demonstrated cardiovascular benefits from more intensive BP targets among ambulatory, less complex older adults, but generalizability to NH residents is questionable. Other trials have demonstrated that de-intensifying antihypertensives in frail, older patients is feasible, with no or modest increases in BP, but most have not assessed effects on patient-centered outcomes. Observational studies with patients more representative of NH residents suggest harms associated with more intensive BP treatment and reduction in fall risk associated with deintensification, but findings and potential for bias vary across studies. Randomized trials and rigorous observational studies examining effects of deintensified BP management on patient-centered outcomes in complex, older populations are needed to inform improved guidelines and treatment for NH residents.