Intensification Of Antihypertensive Regimens During Hospitalization For Unrelated Conditions: Too Much Of A Good Thing?

Steinman, Michael

INTENSIFICATION OF ANTIHYPERTENSIVE REGIMENS DURING HOSPITALIZATION FOR UNRELATED CONDITIONS: TOO MUCH OF A GOOD THING?

Charlie Wray, DO, MS¹, Timothy Anderson, MD², Bocheng Jing, BS, MS³, Kathy Fung, BS, MS⁴, Sarah Ngo, BA², Edison Xu, BS², Michael Steinman, MD, MS², ¹University of California, San Francisco, Mill Valley, CA; ²University of California San Francisco; ³Northern California Institute of Research and Education; ⁴San Francisco VA Medical Center

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract Number: 89

Category: Research

Sub-Category: Geriatrics

Keywords: Geriatrics, Hypertension, Overuse

Background: Transient elevations of blood pressure are common in hospitalized older adults and may lead inpatient clinicians to intensify inpatient antihypertensive therapy and discharge patients on these intensified regimens. Intensification of outpatient regimens during hospitalization can easily become over-treatment once patients return home, increasing patients’ risk of adverse drug events including syncope and falls. Thus, we evaluated the frequency of hospitalized older adults being discharged on intensified antihypertensive regimens.

Methods: We used national VA and Medicare data to identify veterans with an outpatient diagnosis of hypertension who were age 65 years and older and hospitalized in a VA in 2011-2013 with pneumonia, urinary tract infection or venous thromboembolism. Using VA pharmacy dispensing records, we compared antihypertensives prescribed on admission and discharge. We classified regimen changes as intensifications if patients were discharged on a greater number or increased dose of antihypertensives.

Results: Among 14,484 veterans, 97% were male and the median age was 77 (IQR 69-85). Patients were prescribed a median of 1 antihypertensive on admission (IQR 0-2). 26% of patients were discharged with changes to their antihypertensives. Overall, 13% were discharged on an intensified regimen including 11% of patients with well-controlled BP prior to admission. Among the 5% of patients who had >=3 inpatient SBP readings >=180 mmHg, almost half (41%) were discharged on an intensified regimen, including 40% of those with previously well-controlledoutpatient BPs. Intensifications were common in groups less likely to benefit from aggressive BP control: 14% of patients with dementia, 9% of patients with metastatic cancer, and 12% of patients age >85.

Conclusions: One in 8 older adults hospitalized for common non-cardiac conditions were discharged on intensified antihypertensive regimens. Intensifications were common in groups with low likelihood of benefit, including older adults with transient inpatient BP elevations but well-controlled outpatient blood pressure.