Evidence map›Paper›PMID 38950584›Full record

ArticleJournal of the American Medical Directors Association2024

Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents.

Xiaojuan Liu, Bocheng Jing, Laura A Graham, Christine Kee Liu, Sei J Lee, Michael A Steinman, Chintan V Dave, Veena Manja, Yongmei Li, Kathy Fung and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Directors Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Xiaojuan LiuDepartment of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA. Electronic address: xjliu@stanford.edu.
Bocheng JingGeriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Laura A GrahamHealth Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford-Surgery Policy Improvement Research Education Center, Department of Surgery, Stanford University, Stanford, CA, USA.
Christine Kee LiuGeriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Section of Geriatrics, Division of Primary Care and Population Health, Stanford University, School of Medicine, Stanford, CA, USA.
Sei J LeeGeriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Michael A SteinmanGeriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Chintan V DaveDepartment of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.
Veena ManjaCenter for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Health Policy, Stanford University, Stanford, CA, USA.
Yongmei LiDepartment of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
Kathy FungGeriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Michelle C OddenDepartment of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Alexander Keliimoeanu Smith · 2013 to 2026
$19.9M
U.S. Deprescribing Research NetworkR24AG064025 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI BOYD, CYNTHIA MELINDA, STEINMAN, MICHAEL A. · 2019 to 2023
$9.9M
Management of Hypertension among Persons with and without Dementia in Long-Term CareRF1AG062568 · NIA · STANFORD UNIVERSITY · PI ODDEN, MICHELLE CHRISTINA · 2019 to 2019
$3.3M
Deprescribing Cardiovascular Medications among Persons with and without Alzheimer's Disease and Related Dementias in Long-Term CareR01AG062568 · NIA · PALO ALTO VETERANS INSTIT FOR RESEARCH · PI Christine Kee Liu, Michelle Christina Odden · 2024 to 2026
$2.3M
Prescribing cascades in older adults with and without dementiaK24AG049057 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEINMAN, MICHAEL A. · 2015 to 2025
$1.8M
Prognostic calculators for patients with Alzheimers disease and related dementiasR01AG057751 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI LEE, SEI, SMITH, ALEXANDER KELIIMOEANU · 2018 to 2021
$1.5M
Mentoring Patient-Oriented Research to Individualize Care for Hospitalized Older Adults with and without Alzheimer's Disease and Related DementiasK24AG066998 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Sei Lee · 2021 to 2026
$1.1M
NIA NIH HHS K24 AG049057NIA NIH HHS K24 AG066998NIA NIH HHS P30 AG044281NIA NIH HHS R01 AG057751NIA NIH HHS R01 AG062568NIA NIH HHS R24 AG064025NIA NIH HHS RF1 AG062568
6 · The paper itself

Abstract

objectivesAntihypertensive treatment changes are common in long-term care residents, yet data on the frequency and predictors of changes are lacking. We described the patterns of antihypertensive changes and examined the triggering factors.

designRetrospective cohort study. SETTING AND

participantsA total of 24,870 Department of Veterans Affairs (VA) nursing home residents aged ≥65 years with long-term stays (≥180 days) from 2006 to 2019.

methodsWe obtained data from the VA Corporate Data Warehouse. Based on Bar Code Medication Administration medication data, we defined 2 types of change events in 180 days of admission: deprescribing (reduced number of antihypertensives or dose reduction of ≥30% compared with the previous week and maintained for at least 2 weeks) and intensification (opposite of deprescribing). Mortality was identified within 2 years after admission.

resultsMore than 85% of residents were prescribed antihypertensives and 68% of them experienced ≥1 change event during the first 6 months of the nursing home stay. We categorized residents into 10 distinct patterns: no change (27%), 1 deprescribing (11%), multiple deprescribing (5%), 1 intensification (10%), multiple intensification (7%), 1 deprescribing followed by 1 intensification (3%), 1 intensification followed by 1 deprescribing (4%), 3 changes with mixed events (7%), >3 changes with mixed events (10%), and no antihypertensive use (15%). Treatment changes were more frequent in residents with better physical function and/or cognitive function. Potentially triggering factors differed by the type of antihypertensive change: incident high blood pressure and cardiovascular events were associated with intensification, and low blood pressure, weight loss, and falls were associated with deprescribing. Death occurred in 7881 (32%) residents over 2 years. The highest mortality was for those without antihypertensive medication (incidence = 344/1000 person-years). CONCLUSIONS AND IMPLICATIONS: Patterns of medication changes existing in long-term care residents are complex. Future studies should explore the benefits and harms of these antihypertensive treatment changes.

Indexed as

Antihypertensive AgentsLong-Term CareNursing HomesAgedAged, 80 and overDeprescriptionsFemaleHumansHypertensionMaleRetrospective StudiesUnited StatesUnited States Department of Veterans AffairsAntihypertensive Agentsdeprescribingepidemiologyfunctional statushypertensionNursing home

Identifiers

PMID38950584
PMCPMC11368635

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.