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.

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Abstract:

OBJECTIVES: 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. DESIGN: 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. METHODS: 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. RESULTS: 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.