High blood pressure treatment and nursing home residents

Although 27 percent of all older adults who live in nursing homes in this country have both high blood pressure and dementia, we don’t have enough research yet to inform healthcare providers about the best way to treat their high blood pressure.

Specifically, we don’t know when the benefits of taking medication to lower blood pressure outweigh the potential risks, especially in older adults who also have moderate to severe dementia and a poor prognosis (the medical term for the likely course of a disease). That’s because clinical trials for high blood pressure treatments typically do not include older adults who have severe chronic illnesses or disabilities.

A team of researchers designed a study to learn more about the best high blood pressure treatments for older adults who live in nursing homes. Their study was published in the Journal of the American Geriatrics Society.

The research team used information from Medicare records. The team identified 255,670 long-term nursing home residents in the United States during 2013 who had high blood pressure. Of these, nearly half had moderate or severe dementia-related difficulties with thinking and decision-making. Slightly more than half of them had no or only mild cognitive impairment.

The study’s participants were about 85 years old on average. They had moderate impairment of their physical function and about 3 percent were receiving hospice care or had a life expectancy of six months or less.

At the beginning of the study, participants were receiving high blood pressure treatment.

The most common high blood pressure medicines received were beta blockers, followed by calcium channel blockers, and angiotensin converting enzyme (ACE) inhibitors. Nearly half the participants were taking more than one high blood pressure drug.

After following the participants for 180 days, the researchers learned that the residents taking a higher number of high blood pressure medications (more intensive treatment) were slightly more likely to be hospitalized or hospitalized for heart disease than those taking fewer high blood pressure medications. However, they were slightly less likely to experience a decline in their physical abilities than those residents taking fewer high blood pressure medications. This was true whether or not the residents had dementia.

The researchers said that their study’s findings suggest that long-term nursing home residents with high blood pressure do not experience significant benefits from more intensive treatment. “Older adults and their caregivers should be aware that intensive treatment for high blood pressure may not be helpful in long-term nursing home residents. It is reasonable to consider reducing the dose of these drugs or discontinuing their use in residents with dementia, if doing so is consistent with their goals of care.”

###

This summary is from “Hypertension Treatment in U.S. Long-term Nursing Home Residents with and without Dementia.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Kenneth S. Boockvar, MD; Wei Song, MA; Sei Lee, MD; and Orna Intrator, PhD.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation’s work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has–for 75 years–worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.