Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care
Purpose of Review
We sought to summarize recent evidence regarding optimal blood pressure (BP) treatment targets and antihypertensive regimen intensity for nursing home (NH) residents and similar older, complex patients with hypertension.
Recent trials have demonstrated cardiovascular benefits from more intensive BP targets among ambulatory, less complex older adults, but generalizability to NH residents is questionable. Other trials have demonstrated that de-intensifying antihypertensives in frail, older patients is feasible, with no or modest increases in BP, but most have not assessed effects on patient-centered outcomes. Observational studies with patients more representative of NH residents suggest harms associated with more intensive BP treatment and reduction in fall risk associated with deintensification, but findings and potential for bias vary across studies.
Randomized trials and rigorous observational studies examining effects of deintensified BP management on patient-centered outcomes in complex, older populations are needed to inform improved guidelines and treatment for NH residents.
KeywordsNursing homes Hypertension Antihypertensives Deprescribing Older adults Frailty
The authors’ work on this paper was supported by the U.S. Department of Veterans Affairs (IIR 14-306, PI C. Thorpe; Office of Academic Affairs Fellowship in Medication Safety & Pharmacy Outcomes, Michelle Vu).
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
The views expressed are those of the authors and do not represent the views of the Department of Veterans Affairs.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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