To examine the relationship between antihypertensive drug deintensification and recurrent falls in long‐term care.
Department of Veterans Affairs () inpatient, outpatient, and purchased care data, Minimum Data Set assessments from nursing homes (NHs), and Medicare claims from fiscal years 2010 – 2015.
We identified residents with evidence of overaggressive antihypertensive treatment, defined as systolic blood pressure () 80–120 and an index fall. Recurrent fall, hospitalization, and mortality within 30 days were compared between veterans whose antihypertensive medications were deintensified versus those whose antihypertensive medications were not using propensity score methods ().
Among 2,212 residents with possibly overaggressive antihypertensive treatment, 11 percent experienced antihypertensive drug deintensification. Lower blood pressure, >1 antihypertensive drug, no congestive heart failure, fracture from index fall, and older age were associated with higher likelihood of deintensification. Antihypertensive deintensification was associated with statistically significant (‐value < .01) lower risk of recurrent fall among residents with 80–100 (marginal effect = −11.4 percent; = −13.6 percent) and higher risk of death among residents with 101–120 (marginal effect = 2.1 percent, ‐value = .07; with = 4.3 percent, ‐value = .04).
Results provide some needed evidence and guidelines for deintensifying antihypertensive medication among frail older residents; since hypertension is prevalent among 54 percent of residents, the potential impact of new evidence is great.
