Older Adults Receive More Intense Blood Pressure Treatment in Hospital than Before Arriving

One out of every seven adults hospitalized for common, non-cardiac reasons are discharged with more aggressive antihypertensive treatment, according to a new study published in The BMJ. 

The retrospective cohort study assessed data from 14,915 adults aged 65 years and older (median age, 76) with hypertension who were admitted to the hospital with non-cardiac conditions between 2011 and 2013. Prior to admission, 65% of the patients’ (n = 9,636) outpatient blood pressure was well-controlled. At time of discharge, 14% of the total cohort (n = 2,074) was receiving intensified antihypertensive treatment, even though more than half (n = 1,082) had well-controlled blood pressure prior to hospitalization. 

More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home, concludes #BMJResearch @TimAndersonMD https://t.co/8OMNhhDHHc pic.twitter.com/YE9htumSok

— The BMJ (@bmj_latest) September 14, 2018

Among patients whose outpatient blood pressure was previously well-controlled, 8% who did not have elevated inpatient blood pressure, 24% who had moderately elevated inpatient blood pressure, and 40% who had severely elevated inpatient blood pressure left the hospital with more intense antihypertensive regimens. Researchers did not find differences in rates of intensification whether patients were least likely to benefit from a stricter blood pressure regimen (limited life expectancy, dementia, or metastatic malignancy) or in cases where the patient was most likely to benefit (history of myocardial infarction, cerebrovascular disease, or renal disease). 

Regardless of having low life expectancy, dementia, or metastatic cancer older hospitalized patients still having their anti-HTN meds intensified. We can do better…https://t.co/aWfJ9Nyldr. Great work by @UCSFDGIM Fellow @TimAndersonMD and @MikeSteinman pic.twitter.com/TliWKB7u4r

— Charlie M. Wray, DO, MS (@WrayCharles) September 13, 2018

In an accompanying editorial, Nathan M. Stall, geriatrician and research fellow at the Division of Geriatric Medicine, Department of Medicine, University of Toronto, and Chaim M. Bell, professor of medicine and health policy management & evaluation and physician-in-chief at the Division of General Internal Medicine, Sinai Health System, write that while a hospital stay may be a good time to manage chronic disease, all outcomes must be considered. 

https://twitter.com/MikeSteinman/status/1040103090320330753

“Of course, hospital admission may be an opportunity to optimize chronic disease management,” they wrote. “It is important, however, that clinicians pursue a conscientious and judicious approach to intensification of treatment that considers any reversible provoking causes (such as pain and anxiety), the risks and benefits of intensifying treatment (including the recognition that most risk associated with chronic diseases is incurred over the long term rather than the short term), and the availability of the clinician to reassess the effect of treatment throughout the remainder of the admission.” 

The study authors concluded, “More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home.”  

Source: The BMJ