Managing blood pressure medication at discharge

Stall, Nathan M.; Bell, Chaim M.

doi:10.1136/bmj.k3789

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…On the one hand, hospitalization may be an opportune time to set patients on the path toward better long-term BP control . On the other hand, discharging older adults home on intensified antihypertensive regimens may cause more harm than benefit . Short-term increases in BP during hospitalization likely have little long-term significance, yet these increases commonly precipitate treatment intensifications.…”

Section: Introductionmentioning

confidence: 99%

“…4 On the other hand, discharging older adults home on intensified antihypertensive regimens may cause more harm than benefit. 5,6 Short-term increases in BP during hospitalization likely have little long-term significance, yet these increases commonly precipitate treatment intensifications. For older adults with previously well-controlled outpatient BP, intensification of antihypertensive regimens in response to elevated inpatient BPs may lead to overtreatment when they return home.…”

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confidence: 99%

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Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge

et al. 2019

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IMPORTANCE Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization.OBJECTIVE To investigate the association between intensification of antihypertensive regimens at hospital discharge and clinical outcomes after discharge. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, patients 65 years and older with hypertension who were hospitalized in Veterans Health Administration national health system facilities from January 1, 2011, to December 31, 2013, for common noncardiac conditions were studied. Data analysis was performed from October 1, 2018, to March 10, 2019.EXPOSURES Discharge with antihypertensive intensification, defined as receiving a prescription at hospital discharge for a new or higher-dose antihypertensive than was being used before hospitalization. Propensity scores were used to construct a matched-pairs cohort of patients who did and did not receive antihypertensive intensifications at hospital discharge. MAIN OUTCOMES AND MEASURESThe primary outcomes of hospital readmission, serious adverse events, and cardiovascular events were assessed by competing risk analysis. The secondary outcome was the change in systolic BP within 1 year of hospital discharge. RESULTSThe propensity-matched cohort included 4056 hospitalized older adults with hypertension (mean [SD] age, 77 [8] years; 3961 men [97.7%]), equally split between those who did vs did not receive antihypertensive intensifications at hospital discharge. Groups were well matched on all baseline covariates (all standardized mean differences <0.1). Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1. NNH, 63; 95% CI,. At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, −2.4 to 3.7 mm Hg).CONCLUSIONS AND RELEVANCE Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge

et al. 2019

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“…In an accompanying editorial, Nathan M. Stall of the University of Toronto and Chaim M. Bell of Toronto's Sinai Health System wrote, "Whether or not intensied antihypertensive treatment at hospital discharge results in measurable harm, the study ndings highlight two pressing matters of concern to frontline clinicians and researchers: the need for a more judicious approach to the in-hospital management of chronic diseases, especially for older adults; and the need to move beyond more traditional means of medication reconciliation at hospital discharge." 2 They also commented that central to the process is considering patient preferences, including the option to intensify treatment in the outpatient rather than the inpatient setting.…”

Section: Better Medication Reconciliationmentioning

confidence: 99%