ArticleJournal of the American Medical Directors Association2021
Antihypertensive Deprescribing in Older Adult Veterans at End of Life Admitted to Veteran Affairs Nursing Homes.
Article in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Deprescribing in cardiometabolic conditions in older patients: a systematic review.GeroScience · 2023Pooled it
- Effect of an 18-month meditation training on cardiovascular risk in older adults: a secondary analysis of the Age-Well randomized controlled trial.BMC geriatrics · 2024Trial
- The Development of a Framework to Classify Medication Deprescribing Among Patients with Type 2 Diabetes in Primary Care Practices.Journal of clinical medicine · 2026Article
- Approaches to deprescribing cardiovascular medications in patients receiving palliative care: a scoping review.Clinical hypertension · 2026Review
- Antihypertensive Deprescribing and Functional Status in VA Long-Term Care Residents With and Without Dementia.Journal of the American Geriatrics Society · 2025Article
- Defining key deprescribing measures from electronic health data: A multisite data harmonization project.Journal of the American Geriatrics Society · 2025Article
- Antihypertensive Deprescribing and Cardiovascular Events Among Long-Term Care Residents.JAMA network open · 2024Observational
- Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents.Journal of the American Medical Directors Association · 2024Article
- Deprescribing antihypertensive drugs in frail older adults.Australian prescriber · 2024Review
- Clinician and Family Caregiver Perspectives on Deprescribing Chronic Disease Medications in Older Nursing Home Residents Near the End of Life.Drugs & aging · 2024Article
- Deprescribing research in nursing home residents using routinely collected healthcare data: a conceptual framework.BMC geriatrics · 2023Review
- Preferences for deprescribing antihypertensive medications amongst clinicians, carers and people living with dementia: a discrete choice experiment.Age and ageing · 2023Article
- Supporting deprescribing in long-term care: An approach using stakeholder engagement, behavioural science and implementation planning.Exploratory research in clinical and social pharmacy · 2022Article
- Effect of Deintensifying Diabetes Medications on Negative Events in Older Veteran Nursing Home Residents.Diabetes care · 2022Article
- Deprescribing Blood Pressure Treatment in Long-Term Care Residents.Journal of the American Medical Directors Association · 2021Article
- Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life.Current epidemiology reports · 2021Article
Corrections and comments
- Erratum issuedErratum.2021
Authors and funding
13 authors at 7 institutions in 1 country.
Funding
Abstract
objectivesGeriatric palliative care approaches support deprescribing of antihypertensives in older nursing home (NH) residents with limited life expectancy and/or advanced dementia (LLE/AD) who are intensely treated for hypertension (HTN), but information on real-world deprescribing patterns in this population is limited. We examined the incidence and factors associated with antihypertensive deprescribing.
designNational, retrospective cohort study. SETTING AND
participantsOlder Veterans with LLE/AD and HTN admitted to VA NHs in fiscal years 2009-2015 with potential overtreatment of HTN at admission, defined as receiving at least 1 antihypertensive class of medications and mean daily systolic blood pressure (SBP) <120 mm Hg. MEASURES: Deprescribing was defined as subsequent dose reduction or discontinuation of an antihypertensive for ≥7 days. Competing risk models assessed cumulative incidence and factors associated with deprescribing.
resultsWithin our sample (n = 10,574), cumulative incidence of deprescribing at 30 days was 41%. Veterans with the greatest level of overtreatment (ie, multiple antihypertensives and SBP <100 mm Hg) had an increased likelihood (hazard ratio 1.75, 95% confidence interval 1.59, 1.93) of deprescribing vs those with the lowest level of overtreatment (ie, one antihypertensive and SBP ≥100 to <120 mm Hg). Several markers of poor prognosis (ie, recent weight loss, poor appetite, dehydration, dependence for activities of daily living, pain) and later admission year were associated with increased likelihood of deprescribing, whereas cardiovascular risk factors (ie, diabetes, congestive heart failure, obesity), shortness of breath, and admission source from another NH or home/assisted living setting (vs acute hospital) were associated with decreased likelihood. CONCLUSIONS AND IMPLICATIONS: Real-world deprescribing patterns of antihypertensives among NH residents with HTN and LLE/AD appear to reflect variation in recommendations for HTN treatment intensity and individualization of patient care in a population with potential overtreatment. Factors facilitating deprescribing included treatment intensity and markers of poor prognosis. Comparative effectiveness and safety studies are needed to guide clinical decisions around deprescribing and HTN management.
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