Deprescribing Blood Pressure Treatment in Long-Term Care Residents

Older adults over age 65 are susceptible to loss of balance for a variety of reasons including drops in blood pressure with standing (orthostatic hypotension [OH]; Gray-Miceli, Ratcliffe, Thomasson, Quigley, Li & Craelius, 2016). OH is a treatable condition, and cause of falls if detected. Nearly 50% of the 1.43 million older adults in long-term care experience falls (National Center for Injury Prevention and Control, 2017). Falls often occur among older adults in long term care during periods of transitioning, where older adults are susceptible to loss of balance and increased risk to fall. As found in our prior work, older adults with OH may not always experience classic dizziness symptoms that may accompany OH (Gray-Miceli, Ratcliffe, Liu, Wantland & Johnson, 2012; Gray). To better understand this phenomenon, our project adapted a cellphone as an inertial measurement unit attached to the person’s center of mass to determine body sway. The objective of this pilot study was to determine if a relationship was observable during the sit to stand maneuver (StS) while older adults wore a Smartphone measuring three dimensions of motion among older adults who had evidenced of symptoms or OH. A sample of four older adults from a rehabilitation facility who were 65 years of age, receiving physical therapy at the time of testing, were cognitively intact, able to perform the StS maneuver and had no active cancer, fractures or serious injuries were recruited and enrolled. Oh determinations, pulse rate and symptoms of dizziness were elicited during a 30 second StS maneuver. In Patient A and Patient B we present the Z-axis and X-axis of front acceleration and patterns of motion side by side for case comparison while highlighting clinical findings. In Patient B, a greater degree of sway at the start of the StS maneuver is noted. Patient B’s blood pressure also dropped 33 mmHg and there were symptoms of dizziness. Drops in mean arterial blood pressure were greater among those with symptomatic OH. Limitations of this pilot include noise, selection of filters and time stamping of the data. Project aims are to help clinicians prevent falls by further assessing symptoms among elders who suffer from LOB and OH.

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Diurnal blood pressure patterns in long-term care settings

Blood Pressure Monitoring ◽

10.1097/00126097-200204000-00003 ◽

2002 ◽

Vol 7 (2) ◽

pp. 105-109 ◽

Cited By ~ 5

Author(s):

Gillian H. Ice ◽

Gary D. James ◽

Douglas E. Crews

Keyword(s):

Blood Pressure ◽

Long Term Care ◽

Term Care ◽

Blood Pressure Patterns

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Is Tight Blood Pressure Control in Hypertensive Long-Term Care Patients Associated with Adverse Events?

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.01.060 ◽

2015 ◽

Vol 16 (3) ◽

pp. B27

Author(s):

Ahlam Alsomali ◽

Gisele P. Wolf-Klein ◽

Judith Beizer ◽

Lisa Rosen ◽

...

Keyword(s):

Blood Pressure ◽

Adverse Events ◽

Blood Pressure Control ◽

Long Term Care ◽

Pressure Control ◽

Term Care ◽

Tight Blood Pressure Control

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Range in systolic blood pressure and care-needs certification in long-term care insurance in community-dwelling older patients with chronic kidney disease

Journal of International Medical Research ◽

10.1177/0300060517721795 ◽

2017 ◽

Vol 46 (1) ◽

pp. 293-306 ◽

Cited By ~ 1

Author(s):

Taroh Himeno ◽

Tazuo Okuno ◽

Keisuke Watanabe ◽

Kumie Nakajima ◽

Osamu Iritani ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Older Patients ◽

Long Term Care ◽

Community Dwelling ◽

Care Needs ◽

Term Care ◽

Long Term Care Insurance ◽

Older Subjects

Objective Low systolic blood pressure (SBP) is associated with an increased risk for cardiovascular morbidity/mortality in older patients with chronic kidney disease (CKD). The present study evaluated the association between range in blood pressure and first care-needs certification in the Long-term Care Insurance (LTCI) system or death in community-dwelling older subjects with or without CKD. Methods CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 or dipstick proteinuria of + or greater. Our study was conducted in 1078 older subjects aged 65–94 years. Associations were estimated using the Cox proportional hazards model. Results During 5 years of follow-up, 135 first certifications and 53 deaths occurred. Among patients with CKD, moderate SBP (130–159 mmHg) was associated with a significantly lower adjusted risk of subsequent total certification (hazard ratio [HR] = 0.44) and subsequent certification owing to dementia (HR = 0.17) compared with SBP < 130 mmHg. These relationships were not observed in non-CKD subjects. Conclusion Lower SBP of <130 mmHg may predict a higher risk for subsequent first care-needs certification in LTCI, especially for dementia, in community-dwelling patients with CKD.

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Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Hypertension ◽

10.1161/hyp.0000000000000208 ◽

2021 ◽

Author(s):

Vesna D. Garovic ◽

Ralf Dechend ◽

Thomas Easterling ◽

S. Ananth Karumanchi ◽

Suzanne McMurtry Baird ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

The United States ◽

In Utero ◽

Pressure Treatment ◽

Placental Perfusion ◽

Blood Pressure Treatment ◽

Disease Risks ◽

In Pregnancy

Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.

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Deprescribing Blood Pressure Treatment in VA Long-Term Care Residents

Innovation in Aging ◽

10.1093/geroni/igab046.1292 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 334-335

Author(s):

Michelle Odden ◽

Sei Lee ◽

Michael Steinman ◽

Anna Rubinsky ◽

Bocheng Jing ◽

...

Keyword(s):

Blood Pressure ◽

Nursing Home ◽

Antihypertensive Medication ◽

Long Term Care ◽

Nursing Home Residents ◽

Risk Difference ◽

Antihypertensive Medications ◽

Term Care ◽

Triggering Events

Abstract There is growing interest in deprescribing of antihypertensive medications in response to adverse effects, or when a patient’s situation evolves such that the benefits are outweighed by the harms. We conducted a retrospective cohort study to evaluate the incidence and predictors of deprescribing of antihypertensive medication among VA long-term care residents ≥ 65 years admitted between 2006 and 2017. Data were extracted from the VA electronic health record, CMS Minimum Data Set, and Bar Code Medication Administration. Deprescribing was defined as a reduction in the number of antihypertensive medications, sustained for 2 weeks. Potentially triggering events for deprescribing included low blood pressure (<90/60 mmHg), acute renal impairment (creatinine increase of 50%), electrolyte imbalance (potassium below 3.5 mEq/L, sodium decrease by 5 mEq/L), and fall in the past 30 days. Among 22,826 VA nursing home residents on antihypertensive medication, 57% had describing event during their stay (median length of stay = 6 months). Deprescribing events were most common in the first 4 weeks after admission and the last 4 weeks of life. Among potentially triggering events, acute renal impairment was associated with greatest increase in the likelihood of deprescribing over the subsequent 4 weeks: among residents with this event, 32.7% were described compared to 7.3% in those without (risk difference = 25.5%, p<0.001). Falls were associated with the smallest increased risk of deprescribing (risk difference = 2.1%, p<0.001) of the events considered. Deprescribing of antihypertensive medications is common among VA nursing home residents, especially after a potential renal adverse event.

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