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Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study
OBJECTIVES: To assess how often older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment, and to identify markers of appropriateness for these intensifications. DESIGN: Retrospective cohort study. SETTING: US Veterans Administrat...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283373/ https://www.ncbi.nlm.nih.gov/pubmed/30209052 http://dx.doi.org/10.1136/bmj.k3503 |
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author | Anderson, Timothy S Wray, Charlie M Jing, Bocheng Fung, Kathy Ngo, Sarah Xu, Edison Shi, Ying Steinman, Michael A |
author_facet | Anderson, Timothy S Wray, Charlie M Jing, Bocheng Fung, Kathy Ngo, Sarah Xu, Edison Shi, Ying Steinman, Michael A |
author_sort | Anderson, Timothy S |
collection | PubMed |
description | OBJECTIVES: To assess how often older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment, and to identify markers of appropriateness for these intensifications. DESIGN: Retrospective cohort study. SETTING: US Veterans Administration Health System. PARTICIPANTS: Patients aged 65 years or over with hypertension admitted to hospital with non-cardiac conditions between 2011 and 2013. MAIN OUTCOME MEASURES: Intensification of antihypertensive treatment, defined as receiving a new or higher dose antihypertensive agent at discharge compared with drugs used before admission. Hierarchical logistic regression analyses were used to control for characteristics of patients and hospitals. RESULTS: Among 14 915 older adults (median age 76, interquartile range 69-84), 9636 (65%) had well controlled outpatient blood pressure before hospital admission. Overall, 2074 (14%) patients were discharged with intensified antihypertensive treatment, more than half of whom (1082) had well controlled blood pressure before admission. After adjustment for potential confounders, elevated inpatient blood pressure was strongly associated with being discharged on intensified antihypertensive regimens. Among patients with previously well controlled outpatient blood pressure, 8% (95% confidence interval 7% to 9%) of patients without elevated inpatient blood pressure, 24% (21% to 26%) of patients with moderately elevated inpatient blood pressure, and 40% (34% to 46%) of patients with severely elevated inpatient blood pressure were discharged with intensified antihypertensive regimens. No differences were seen in rates of intensification among patients least likely to benefit from tight blood pressure control (limited life expectancy, dementia, or metastatic malignancy), nor in those most likely to benefit (history of myocardial infarction, cerebrovascular disease, or renal disease). CONCLUSIONS: One in seven older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment. More than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home. |
format | Online Article Text |
id | pubmed-6283373 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-62833732018-12-26 Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study Anderson, Timothy S Wray, Charlie M Jing, Bocheng Fung, Kathy Ngo, Sarah Xu, Edison Shi, Ying Steinman, Michael A BMJ Research OBJECTIVES: To assess how often older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment, and to identify markers of appropriateness for these intensifications. DESIGN: Retrospective cohort study. SETTING: US Veterans Administration Health System. PARTICIPANTS: Patients aged 65 years or over with hypertension admitted to hospital with non-cardiac conditions between 2011 and 2013. MAIN OUTCOME MEASURES: Intensification of antihypertensive treatment, defined as receiving a new or higher dose antihypertensive agent at discharge compared with drugs used before admission. Hierarchical logistic regression analyses were used to control for characteristics of patients and hospitals. RESULTS: Among 14 915 older adults (median age 76, interquartile range 69-84), 9636 (65%) had well controlled outpatient blood pressure before hospital admission. Overall, 2074 (14%) patients were discharged with intensified antihypertensive treatment, more than half of whom (1082) had well controlled blood pressure before admission. After adjustment for potential confounders, elevated inpatient blood pressure was strongly associated with being discharged on intensified antihypertensive regimens. Among patients with previously well controlled outpatient blood pressure, 8% (95% confidence interval 7% to 9%) of patients without elevated inpatient blood pressure, 24% (21% to 26%) of patients with moderately elevated inpatient blood pressure, and 40% (34% to 46%) of patients with severely elevated inpatient blood pressure were discharged with intensified antihypertensive regimens. No differences were seen in rates of intensification among patients least likely to benefit from tight blood pressure control (limited life expectancy, dementia, or metastatic malignancy), nor in those most likely to benefit (history of myocardial infarction, cerebrovascular disease, or renal disease). CONCLUSIONS: One in seven older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment. More than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home. BMJ Publishing Group Ltd. 2018-09-13 /pmc/articles/PMC6283373/ /pubmed/30209052 http://dx.doi.org/10.1136/bmj.k3503 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Research Anderson, Timothy S Wray, Charlie M Jing, Bocheng Fung, Kathy Ngo, Sarah Xu, Edison Shi, Ying Steinman, Michael A Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
title | Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
title_full | Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
title_fullStr | Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
title_full_unstemmed | Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
title_short | Intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
title_sort | intensification of older adults’ outpatient blood pressure treatment at hospital discharge: national retrospective cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283373/ https://www.ncbi.nlm.nih.gov/pubmed/30209052 http://dx.doi.org/10.1136/bmj.k3503 |
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