Systolic blood pressure, antihypertensive treatment, and cardiovascular and mortality risk in VA nursing home residents

Xiaojuan Liu; Michael A Steinman; Sei J Lee; Carmen A Peralta; Laura A Graham; Yongmei Li; Bocheng Jing; Kathy Z Fung; Michelle C Odden

doi:10.1111/jgs.18301

Systolic blood pressure, antihypertensive treatment, and cardiovascular and mortality risk in VA nursing home residents

J Am Geriatr Soc. 2023 Jul;71(7):2131-2140. doi: 10.1111/jgs.18301. Epub 2023 Feb 24.

Authors

Xiaojuan Liu^{1

2}, Michael A Steinman^{3

4}, Sei J Lee^{3

4}, Carmen A Peralta^{5

6}, Laura A Graham⁷, Yongmei Li^{1

2}, Bocheng Jing⁴, Kathy Z Fung^{3

4}, Michelle C Odden^{1

2}

Affiliations

¹ Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA.
² Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, USA.
³ Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
⁴ Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, California, USA.
⁵ Kidney Health Research Collaborative, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA.
⁶ Cricket Health, Inc, San Francisco, California, USA.
⁷ Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California, USA.

Abstract

Background: Optimal systolic BP (SBP) control in nursing home residents is uncertain, largely because this population has been excluded from clinical trials. We examined the association of SBP levels with the risk of cardiovascular (CV) events and mortality in Veterans Affairs (VA) nursing home residents on different numbers of antihypertensive medications.

Methods: Our study included 36,634 residents aged ≥65 years with a VA nursing home stay of ≥90 days from October 2006-June 2019. SBP was averaged over the first week after admission and divided into categories. Cause-specific hazard ratios (HRs) of SBP categories with CV events (primary outcome) and all-cause mortality (secondary outcome) were examined using Cox regression and multistate modeling stratified by the number of antihypertensive medications used at admission (0, 1 or 2, and ≥3 medications).

Results: More than 76% of residents were on antihypertensive therapy and 20% received ≥3 medications. In residents on antihypertensive therapy, a low SBP < 110 mmHg (compared with SBP 130 ~ 149 mmHg) was associated with a greater CV risk (adjusted HR [95% confidence interval]: 1.47 [1.28-1.68] in 1 or 2 medications group, and 1.41 [1.19-1.67] in ≥3 medications group). In residents on no antihypertensives, both low SBP < 110 mmHg and high SBP ≥ 150 mmHg were associated with higher mortality; while in residents receiving any antihypertensives, a low SBP was associated with higher mortality and the highest point estimates were for SBP < 110 mmHg (1.36 [1.28-1.45] in 1 or 2 medications group, and 1.47 [1.31-1.64] in ≥3 medications group).

Conclusions: The associations of SBP with CV and mortality risk varied by the intensity of antihypertensive treatment among VA nursing home residents. A low SBP among those receiving antihypertensives was associated with increased CV and mortality risk, and untreated high SBP was associated with higher mortality. More research is needed on the benefits and harms of SBP lowering in long-term care populations.

Keywords: antihypertensive treatment; cardiovascular events; long-term care residents; mortality; systolic blood pressure.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Antihypertensive Agents / pharmacology
Antihypertensive Agents / therapeutic use
Blood Pressure / physiology
Humans
Hypertension* / complications
Hypotension* / complications
Nursing Homes

Substances

Antihypertensive Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding