Intensifying BP Meds at Hospital Discharge May Harm Elderly

Increasing blood pressure medications at hospital discharge for elderly patients hospitalized with noncardiac conditions does not improve long-term outcomes and is tied to short-term harms, according to a study published online in JAMA Internal Medicine.

Timothy S. Anderson, M.D., from University of California in San Francisco, and colleagues examined the association between intensification of antihypertensive regimens at hospital discharge and clinical outcomes after discharge among older patients (mean age, 77 years; 97.7 percent male) with hypertension who were hospitalized for common noncardiac conditions in Veterans Health Administration national health system facilities from 2011 through 2013.

The researchers found that within 30 days, patients receiving intensifications had a higher risk for readmission (hazard ratio [HR], 1.23 [95 percent confidence interval (CI), 1.07 to 1.42]; number needed to harm [NNH], 27 [95 percent CI, 16 to 76]) and serious adverse events (HR, 1.41 [95 percent CI, 1.06 to 1.88]; NNH, 63 [95 percent CI, 34 to 370]). Compared with those not receiving intensification, at one year, there were no differences in cardiovascular events (HR, 1.18; 95 percent CI, 0.99 to 1.40) or change in systolic blood pressure (mean blood pressure, 134.7 versus 134.4; difference-in-differences estimate, 0.6 mm Hg; 95 percent CI, −2.4 to 3.7 mm Hg).

"The findings suggest that intensification of antihypertensives at hospital discharge is associated with short-term harms without long-term benefits, and should generally be avoided in older adults hospitalized for noncardiac conditions," the authors write.

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