Intensifying Antihypertensives at Discharge Tied to Adverse Events

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Intensifying antihypertensive regimens of older adults who were hospitalized for noncardiac conditions is associated with several harms and doesn't appear to reduce cardiovascular events, a JAMA Internal Medicine study finds.

Using Veterans Affairs' data, researchers assessed outcomes in patients aged 65 and older with hypertension who were admitted to a VA hospital for pneumonia, urinary tract infection, or venous thromboembolism. Roughly 14% were discharged with intensified antihypertensive regimens — a dose increase of 20% or more. Researchers matched 4100 patients who had treatment intensifications with those who did not.

Thirty-day readmission rates were higher among those with treatment intensification (21% vs. 18%). Those patients also had higher rates of serious adverse events at 30 days (5% vs. 3%). However, cardiovascular events at 1 year were statistically similar between groups (around 13%).

The authors conclude: "Shifting practice from intensifying antihypertensive regimens during hospitalization to communicating concerns about patients' long-term BP control to outpatient practitioners for close follow-up may provide a safer treatment path for patients."