Increasing blood pressure meds for elderly patients increases risk of readmission due to falls and kidney injury

Blood pressure medications might reduce the risk of cardiometabolic conditions, but researchers from the University of California, San Francisco (UCSF) found that healthcare professionals might be doing more harm than good in prescribing more intense medications.

Published in JAMA Internal Medicine, their results demonstrated that patients admitted for non-cardiac conditions but had high blood pressure had a greater risk of readmission, falls, fainting and renal damage if placed on intensified blood pressure treatment.

Timothy Anderson, the lead author of the study and an internal medicine specialist based in San Francisco, noted that their findings suggest increasing blood pressure medications in patients admitted for non-cardiac conditions is not beneficial.

Increasing blood pressure medication upon discharge raises the risk of hospital readmission

To determine if the intensification of blood pressure medication influenced a patient’s health after discharge, the team studied a cohort of 4,056 patients aged 65 or older that had high blood pressure.

The patients had been hospitalized in the Veterans Health Administration facilities from 2011–2013 for non-cardiac conditions.

It appeared that patients placed on higher doses of blood pressure medication upon discharge had higher rates of hospital readmission. In fact, their risk of readmission is 21.4 percent higher than patients that remained on their prescribed treatment (17.7 percent).

Furthermore, the intensified blood pressure treatment neither reduced the risk of heart disease nor enhanced blood pressure control a year after discharge. On the contrary, it led to a greater risk of falls, fainting and renal damage in 4.5 percent of patients placed on the said treatment just a month after discharge.

In a similar vein, 3.1 percent of patients that remained on their current blood pressure treatment upon discharge exhibited an elevated risk of the same adverse events a month after discharge.

All in all, these results indicate that intensified blood pressure treatment after hospitalization is not beneficial, said Anderson.

It also appears that healthcare professionals assigned to outpatient care, not inpatient clinicians that might prescribe more medications, are best consulted regarding treatments post-admission, he added.

More guidance needed in managing high blood pressure during hospital admission

It’s not uncommon for blood pressure readings taken during hospital admission to be inconsistent.

Past studies found that inconsistent readings or fluctuations during hospital admission are often the result of pain, stress, anxiety and the use of different medications during hospital admission, not heart disease and other cardiometabolic conditions.

That being said, these fluctuations might lead clinicians to place patients on an intensified blood pressure treatment to help control blood pressure better. But as Anderson and his colleagues found, intensifying blood pressure treatments is not necessarily the best course of action given such a case.

In 2018, Anderson and another team of UCSF researchers found that one in seven adults aged 65 or older admitted for non-cardiac medical conditions is placed on intensified blood pressure medications upon discharge.

Published in the British Medical Journal, their results demonstrated that more than half of the intensifications occurred in patients that had raised blood pressure readings during their admission but had stable readings prior.

In addition, the team found no significant differences in the rates of intensification among patients that do require tight blood pressure control and those that don’t.

Their findings also indicate that the decision to place patients on intensified blood pressure treatment upon discharge is often based on inpatient blood pressure readings, not outpatient readings that might indicate improvements over the course of the admission.

Therefore, healthcare professionals assigned to outpatient care might be better equipped than inpatient clinicians in doling out recommendations and treatments for post-discharge care.

Taken together, the findings of both studies suggest that more control is needed to curb the possible harmful effects of intensified blood pressure treatment in older patients.

Healthcare professionals might also require more guidance in managing raised blood pressure during hospital admission. (Related: Homeopathic remedies for high blood pressure.)

Learn more about high blood pressure and its cardiometabolic complications at Heart.news.

Sources include:

DailyMail.co.uk

JAMANetwork.com

BMJ.com