Evidence map›Paper›PMID 39585693›Full record

Observational studyJAMA network open2024

Antihypertensive Deprescribing and Cardiovascular Events Among Long-Term Care Residents.

Michelle C Odden, Laura A Graham, Xiaojuan Liu, Chintan V Dave, Sei J Lee, Yongmei Li, Bocheng Jing, Kathy Fung, Carmen A Peralta, Michael A Steinman

Abstract readObservational Study
In one paragraph

Observational study in JAMA network open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Review
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

10 authors.

Michelle C OddenGeriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California.
Laura A GrahamHealth Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California.
Xiaojuan LiuDepartment of Epidemiology and Population Health, Stanford University, Stanford, California.
Chintan V DaveCenter for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.
Sei J LeeDivision of Geriatrics, Department of Medicine, University of California San Francisco.
Yongmei LiDepartment of Epidemiology and Population Health, Stanford University, Stanford, California.
Bocheng JingDivision of Geriatrics, Department of Medicine, University of California San Francisco.
Kathy FungDivision of Geriatrics, Department of Medicine, University of California San Francisco.
Carmen A PeraltaKidney Health Research Collaborative, University of California San Francisco and San Francisco VA Medical Center, San Francisco.
Michael A SteinmanDivision of Geriatrics, Department of Medicine, University of California San Francisco.

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI REBECCA L SUDORE · 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
Evaluating the role of multimorbidity in modulation medication effects in older adultsR01HL163163 · NHLBI · RUTGERS BIOMEDICAL AND HEALTH SCIENCES · PI Chintan Dave · 2023 to 2026
$2.7M
The U.S. Deprescribing Research NetworkR33AG086944 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI CYNTHIA Melinda BOYD, MICHAEL A. STEINMAN · 2024 to 2026
$2.5M
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
(R01) Strengthening the Evidence-Base to Support Medication Prescribing in Older Adults with Chronic Kidney DiseaseR01DK139163 · NIDDK · RUTGERS BIOMEDICAL AND HEALTH SCIENCES · PI Chintan Dave · 2025 to 2026
$1.3M
NHLBI NIH HHS R01 HL163163NIA NIH HHS K24 AG049057NIA NIH HHS L30 AG069245NIA NIH HHS P30 AG044281NIA NIH HHS R01 AG057751NIA NIH HHS R01 AG062568NIA NIH HHS R24 AG064025NIA NIH HHS R33 AG086944NIA NIH HHS RF1 AG062568NIDDK NIH HHS R01 DK139163
6 · The paper itself

Abstract

Importance: The practice of deprescribing antihypertensive medications is common among long-term care residents, yet the effect on cardiovascular outcomes is unclear. Objective: To compare the incidence of hospitalization for myocardial infarction (MI) or stroke among long-term care residents who are deprescribed or continue antihypertensive therapy. Design, Setting, and Participants: This comparative effectiveness research study used target trial emulation with observational electronic health record data from long-term care residents aged 65 years or older admitted to US Department of Veterans Affairs community living centers between October 1, 2006, and September 30, 2019, and taking at least 1 antihypertensive medication. Analyses were conducted between August 2023 and August 2024. Exposure: A reduction in the number of antihypertensive medications or dose (by ≥30%), assessed using barcode medication administration data. Main Outcome and Measures: Incidence of MI and stroke hospitalization up to 2 years was assessed using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. A pooled logistic regression model with inverse probability of treatment weighting (IPTW) and inverse probability of censoring weighting (IPCW) was used to estimate per-protocol effects. Results: Of 13 096 long-term care residents (97.4% men; median age, 77 years [IQR, 70-84 years]) taking antihypertensive medication, 17.8% were deprescribed antihypertensive medication over a period of 12 weeks. The estimated unadjusted cumulative incidence of stroke or MI hospitalization over 2 years was similar among residents who were and were not deprescribed antihypertensives in per-protocol analyses (11.2% vs 8.8%; difference, 2.4 percentage points [95% CI, -2.3 to 7.1 percentage points]). Participant characteristics were balanced after applying IPTW and IPCW; all standardized mean differences were less than 0.05. After full adjustment for confounding and informative censoring, the per-protocol analysis results showed no association of antihypertensive deprescribing with MI or stroke hospitalization (hazard ratio, 0.93; 95% CI, 0.70-1.26). Conclusions and Relevance: In this comparative effectiveness research study, deprescribing antihypertensive medication was not associated with risk of hospitalization for MI or stroke in long-term care residents. These findings may be informative for long-term care residents and clinicians who are considering deprescribing antihypertensive medications.

Indexed as

Antihypertensive AgentsDeprescriptionsHospitalizationLong-Term CareMyocardial InfarctionStrokeAgedAged, 80 and overComparative Effectiveness ResearchFemaleHumansHypertensionIncidenceMaleUnited StatesAntihypertensive Agents

Identifiers

PMID39585693
PMCPMC11589794

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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.