Overtreatment of BP common upon discharge, says study

Paying close attention to discharge meds could reduce harmful overtreatment

Clinicians may be over treating blood pressure (BP) in older adults admitted to the hospital for non-cardiac conditions by intensifying antihypertensive regimens at discharge, primarily in patients with previously well-controlled outpatient BP, according to results of an observational study published in BMJ. The data highlight the need for clinicians to pay close attention to discharge medications to reduce potentially harmful overtreatment of BP as older adults transition from the hospital to the home. 

Anderson and colleagues from the San Francisco Veterans Affairs (VA) and University of California conducted a retrospective cohort study of 14,915 older patients (≥ 65 years) who had a diagnosis of hypertension and were admitted to a VA hospital between 2011 and 2013 for a non-cardiac condition to determine how often these patients were discharged with an intensified antihypertensive regimen. Patients had a median age of 77 years, were mainly male (96.8%), and were admitted with conditions such as pneumonia, urinary tract infection, or venous thromboembolism. Assessment of BP control before admission showed that 65% of patients had well-controlled outpatient BP, 32% had high outpatient BP, and 2% had very high outpatient BP. Patients were prescribed a median of one antihypertensive treatment upon admission.

The data showed that 19% of patients had moderately elevated inpatient BP and 5% had severe elevations; and 47% of patients with elevated levels had normal BPs before admission. Overall, 14% of patients were discharged with an intensified antihypertensive treatment, with more than half of these patients having well-controlled BP before admission. This resulted in 1 in 7 adults being discharged on an intensified regimen, with decisions to intensify regimens primarily based on inpatient BP measurements and not on the overall context of the patient’s health or long-term disease control. The study did not assess whether intensification of the BP regimen resulted in any drug-related harms.    

For the full article, please visit www.pharmacytoday.org for the December 2018 issue of Pharmacy Today.