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Older adults discharged with antihypertensives at significant risk for readmission

Adults 65 years and older hospitalized for noncardiac reasons and discharged with intensified antihypertensives had no difference in BP control after 1 year, but were at increased risk for readmission within 30 days, according to study results presented at the American Geriatrics Society’s annual meeting.

Transient elevations of BP are common in older adults who are hospitalized, which frequently causes clinicians to discharge those patients with intensified antihypertensive medication regimens and potentially expose them to overtreatment, Timothy Santeler Anderson, MD, MAS, MA, of the University of California San Francisco, and colleagues explained in the study abstract.

Researchers examined national VA and Medicare data from veterans 65 years and older who were hospitalized in a VA center from 2011 to 2013 for pneumonia, urinary tract infection or venous thromboembolism. Patients discharged with intensified antihypertensives were compared with those who were on different regimens or were not receiving antihypertensive medications.

The primary outcomes of the study were serious adverse event readmissions within 30 days and cardiovascular readmissions within 1 year. The secondary outcome was change in systolic BP within 1 year of discharge.

A total of 4,056 patients were enrolled in the matched cohort, with an equal number of patients who were discharged with intensified antihypertensives and patients who were not. The median age of the study population was 77 years. Patients who received intensifications had a significantly higher risk of serious adverse event readmission (HR = 1.41; 95% CI, 1.06-1.88) and all-cause readmission (HR = 1.23; 95% CI, 1.07-1.42) within 30 days of discharge. There was no difference in cardiovascular readmissions or change in systolic BP within 1 year of discharge between the groups.

In the 2,244 matched pairs with a systolic BP less than 140 mm Hg prior to hospitalization, those who received intensifications had a significantly higher risk for serious adverse event readmission within 30 days and cardiovascular readmission within 1 year (all P < 0.05).

“These findings indicate that despite its common practice, intensification of antihypertensive regimens during hospitalization poses greater risks to older adults than benefits,” Anderson and colleagues wrote. – by Erin Michael

Reference:

Anderson TS, et al. Clinical outcomes of intensifying older adults’ antihypertensives at hospital discharge. Presented at: American Geriatrics Society; May 1-4, 2019; Portland, Oregon.

Disclosures: Anderson reports no relevant financial disclosures.