Deprescribing antihypertensive medication not tied to risk of stroke or MI hospitalization in long-term care: JAMA
Researchers have found that in the long-term care setting, among residents aged 65 years and older, deprescribing of antihypertensive medications does not significantly increase risk for hospitalization with a diagnosis of myocardial infarction (MI) or stroke. A recent study was published in the journal JAMA Network Open conducted by Michelle and colleagues.
Retrospective comparative effectiveness research study used data from the long-term care residents who were admitted to Veterans Affairs (VA) community living centers between October 1, 2006, and September 30, 2019. The participants were over 65 years of age and were on at least one antihypertensive medication.
Deprescribing was operationally defined as at least 30% reduction in medication dose or number, measured over a follow-up period of 12 weeks. The main outcomes are defined as hospitalization due to MI or stroke, any time within two years post follow-up, and evaluated according to International Classification of Diseases (ICD-9 and ICD-10) codes. The study applied pooled logistic regression with inverse probability of treatment and censoring weighting (IPTW and IPCW) to correct the biases due to confounding.
The key findings were:
• The study comprised 13,096 long-term care residents, whose median age was 77 years (IQR, 70-84 years). Of these, 97.4% were men.
• Of the residents, 17.8% of them had their antihypertensive medication deprescribed in a period exceeding 12 weeks.
• The unadjusted cumulative incidence of MI or stroke hospitalization within two years for those deprescribed was 11.2%, and for the continued therapy, it was 8.8% (difference: 2.4 percentage points; 95% CI: −2.3 to 7.1).
• After full adjustment, there was no significant association between deprescribing and increased risk of MI or stroke (hazard ratio: 0.93; 95% CI: 0.70-1.26).
• The participant characteristics were well-balanced after applying IPTW and IPCW, with standardized mean differences of less than 0.05 for all variables.
In older residents of long-term care facilities, deprescribing antihypertensive drugs did not increase the risk for hospitalization for acute MI or stroke. The results support the safe introduction of deprescribing in elderly populations, providing clinicians with a data-driven strategy for minimizing the burden of medications without loss of cardiovascular safety.
Reference:
Odden, M. C., Graham, L. A., Liu, X., Dave, C. V., Lee, S. J., Li, Y., Jing, B., Fung, K., Peralta, C. A., & Steinman, M. A. (2024). Antihypertensive deprescribing and cardiovascular events among long-term care residents. JAMA Network Open, 7(11), e2446851. https://doi.org/10.1001/jamanetworkopen.2024.46851
