May 07, 2018
De-intensification of antihypertensive therapies in nursing home residents may lessen their risk for recurrent falls, according to new findings.
Researchers arrived at this conclusion following a study of 19,297 veterans in US Department of Veterans’ Affairs nursing homes who had hypertension that was treated with at least 1 of 5 commonly used drug classes.
Vital sign data, bar-coded administration records, encounter data, and the Minimum Data Set from 2010 to 2015 were used to identify eligible participants.
The researchers defined an index fall as a fall that occurred 3 days or less after a systolic blood pressure (SBP) reading of 80 to 100 or 101 to 120, which suggested aggressive blood pressure control. They also defined drug de-intensification as a dose decrease or discontinuation of an antihypertensive without substitution in the subsequent 7 days.
A total of 3436 nursing home residents had falls during a median stay of 611.5 days. A total of 730 falls were preceded by an SBP of 80 to 100, and 1528 were preceded by an SBP of 101 to 120. Antihypertensive de-intensification occurred in 245 and 381 patients, respectively.
Results showed that residents with antihypertensive de-intensification had lower 30-day subsequent fall risks compared with those without de-intensification. Approximately 11.0% vs 18.1% falls were preceded by an SBP of 80 to 100 (relative risk [RR] 0.61), and 12.9% vs 17.6% were preceded by an SBP of 101 to 120 (RR 0.73).
“Among VA NH residents who had a fall and low SBP, 25% to 34% had de-intensification of their antihypertensive medication,” the researchers wrote. “Those who experienced drug de-intensification had a significantly lower risk of subsequent fall.”
“Antihypertensive de-intensification may reduce recurrent falls in [nursing home] residents with evidence of aggressive blood pressure control,” they concluded.
These findings were presented at the American Geriatrics Society 2018 Annual Scientific Meeting, which is taking place from May 3 to 5 in Orlando, Florida.
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