A study conducted by researchers at UC San Francisco and elsewhere warns that intensifying blood pressure medication when discharging older patients from the hospital may lead to higher risks of falls, fainting, and acute kidney injury.
These potential adverse effects may outweigh the potential benefits of such a regimen.
Methodology
The research involved more than 4,000 VA patients, all of whom were at least 65 years old and were hospitalized for non-cardiac conditions.
The researchers examined the impact of intensified antihypertensive treatment upon discharge.
Key Findings
The researchers found that intensified antihypertensives upon discharge did not reduce cardiovascular events or improve blood pressure control after a year.
However, they did increase the risk for readmission and serious adverse events within 30 days.
At 30 days post-discharge, patients on blood pressure medication had a significantly higher risk for readmission to the hospital and experiencing medication-related serious adverse events such as falls, fainting, and acute kidney injury.
This is compared to patients who did not receive additional antihypertensives.
The study found no reduction in blood pressure or readmission to the hospital for cardiovascular conditions within a year after discharge among patients who received intensified antihypertensives.
Comments from the Researchers
Lead author Timothy Anderson, MD, MAS, MA, a primary care research fellow in the Division of General Internal Medicine at UCSF, commented that “Blood pressure management is about long-term control, but during hospitalization, patients’ blood pressure can be temporarily elevated in response to illness and stress.
Our findings suggest that making medication changes during this period is not beneficial.”
Instead, he suggested that deferring medication adjustments to outpatient doctors once patients have recovered from their acute illness is likely a safer course.
Senior author Michael Steinman, MD, a UCSF professor of geriatrics, stated that the right time to start blood pressure medications is not when patients are hospitalized for other conditions.
The authors recommend that hospital clinicians review patients’ prior blood pressure and medication records, and communicate elevated inpatient blood pressure readings to patients’ outpatient providers for further management following discharge, rather than simply prescribing more blood pressure medications.
Significance
This research adds to the understanding of the optimal management of blood pressure in older adults hospitalized for non-cardiac conditions.
It suggests that intensifying antihypertensive treatment upon discharge may pose health risks.
The researchers are now looking into how diabetes medications are impacted by hospitalization and the long-term outcomes associated with those decisions.
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The study was published in JAMA Internal Medicine.
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