HSR&D Citation Abstract
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Deprescribing Blood Pressure Treatment in Long-Term Care Residents.
Odden MC, Lee SJ, Steinman MA, Rubinsky AD, Graham L, Jing B, Fung K, Marcum ZA, Peralta CA. Deprescribing Blood Pressure Treatment in Long-Term Care Residents. Journal of The American Medical Directors Association. 2021 Dec 1; 22(12):2540-2546.e2.
To evaluate the incidence of deprescribing of antihypertensive medication among older adults residing in Veterans Affairs (VA) nursing homes for long-term care and rates of deprescribing after potentially triggering events.
Retrospective cohort study.
SETTING AND PARTICIPANTS:
Long-term care residents aged 65 years and older admitted to a VA nursing home from 2006 to 2019 and using blood pressure medication at admission.
Data were extracted from the VA electronic health record, and Centers for Medicare and Medicaid Services Minimum Data Set and Bar Code Medication Administration. Deprescribing was defined on a rolling basis as a reduction in the number or dose of antihypertensive medications, sustained for = 2 weeks. We examined potentially triggering events for deprescribing, including low blood pressure ( < 90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and falls.
Among 31,499 VA nursing home residents on antihypertensive medication, 70.4% had = 1 deprescribing event (median length of stay = 6 months), and 48.7% had a net reduction in antihypertensive medications over their stay. Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, a 50% increase in serum creatinine was associated with the greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: residents with this event had a 41.7% chance of being deprescribed compared with 11.5% in those who did not (risk difference = 30.3%, P < .001). A fall in the past 30 days was associated with the smallest magnitude increased risk of deprescribing (risk difference = 3.8%, P < .001) of the events considered.
CONCLUSIONS AND IMPLICATIONS:
Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event.