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 Findings Recent trials have demonstrated cardiovascula...

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Bibliographic Details
Published in:	Current hypertension reports Vol. 22; no. 1; p. 8
Main Authors:	Vu, Michelle, Schleiden, Loren J., Harlan, Michelle L., Thorpe, Carolyn T.
Format:	Journal Article
Language:	English
Published:	New York Springer US 14-01-2020 Springer Nature B.V
Subjects:	Age Aged Antihypertensive Agents - therapeutic use Blood pressure Cardiology Cardiovascular disease Clinical medicine Clinical trials Cognitive ability Complex patients Family Medicine Frailty General Practice Guidelines/Clinical Trials/Meta-Analysis (WJ Kostis Humans Hypertension Hypertension - drug therapy Internal Medicine Life expectancy Medicine Medicine & Public Health Metabolic Diseases Nephrology Nursing Homes Older people Patients Pharmacy Primary Care Medicine Section Editor Topical Collection on Guidelines/Clinical Trials/Meta-Analysis Hypertension Nursing homes Frailty Antihypertensives Deprescribing Older adults
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Summary:	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 Findings 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. Summary 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-2
ISSN:	1522-6417 1534-3111
DOI:	10.1007/s11906-019-1012-1