Publication:
Clinical outcomes of modifying hypertension treatment intensity in older adults treated to low blood pressure.

cris.virtual.author-orcid0000-0001-8325-8784
cris.virtualsource.author-orcid1c8384f1-19de-482d-9325-e7459665886a
cris.virtualsource.author-orciddcf039b3-51b9-457e-aa4f-439d935925b3
datacite.rightsopen.access
dc.contributor.authorAubert, Carole Elodie
dc.contributor.authorHa, Jin-Kyung
dc.contributor.authorKim, Hyungjin Myra
dc.contributor.authorRodondi, Nicolas
dc.contributor.authorKerr, Eve A
dc.contributor.authorHofer, Timothy P
dc.contributor.authorMin, Lillian
dc.date.accessioned2024-09-21T15:59:28Z
dc.date.available2024-09-21T15:59:28Z
dc.date.issued2021-10
dc.description.abstractBACKGROUND/OBJECTIVES Hypertension treatment reduces cardiovascular events. However, uncertainty remains about benefits and harms of deintensification or further intensification of antihypertensive medication when systolic blood pressure (SBP) is tightly controlled in older multimorbid patients, because of their frequent exclusion in trials. We assessed the association of hypertension treatment deintensification or intensification with clinical outcomes in older adults with tightly controlled SBP. DESIGN Longitudinal cohort study (2011-2013) with 9-month follow-up. SETTING U.S.-nationwide primary care Veterans Health Administration healthcare system. PARTICIPANTS Veterans aged 65 and older with baseline SBP <130 mmHg and ≥1 antihypertensive medication during ≥2 consecutive visits (N = 228,753). EXPOSURE Deintensification or intensification, compared with stable treatment. MAIN OUTCOMES AND MEASURES Cardiovascular events, syncope, or fall injury, as composite and distinct outcomes, within 9 months after exposure. Adjusted logistic regression and inverse probability of treatment weighting (IPTW, sensitivity analysis). RESULTS Among 228,753 patients (mean age 75 [SD 7.5] years), the composite outcome occurred in 11,982/93,793 (12.8%) patients with stable treatment, 14,768/72,672 (20.3%) with deintensification, and 11,821/62,288 (19.0%) with intensification. Adjusted absolute outcome risk (95% confidence interval) was higher for deintensification (18.3% [18.1%-18.6%]) and intensification (18.7% [18.4%-19.0%]), compared with stable treatment (14.8% [14.6%-15.0%]), p < 0.001 for both effects in the multivariable model). Deintensification was associated with fewer cardiovascular events than intensification. At baseline SBP <95 mmHg, cardiovascular event risk was similar for deintensification and stable treatment, and fall risk lower for deintensification than intensification. IPTW yielded similar results. Mean follow-up SBP was 124.1 mmHg for stable treatment, 125.1 mmHg after deintensification (p < 0.001), and 124.0 mmHg after intensification (p < 0.001). CONCLUSION Antihypertensive treatment deintensification in older patients with tightly controlled SBP was associated with worse outcomes than continuing same treatment intensity. Given higher mortality among patients with treatment modification, confounding by indication may not have been fully corrected by advanced statistical methods for observational data analysis.
dc.description.numberOfPages11
dc.description.sponsorshipBerner Institut für Hausarztmedizin (BIHAM)
dc.identifier.doi10.48350/156885
dc.identifier.pmid34097300
dc.identifier.publisherDOI10.1111/jgs.17295
dc.identifier.urihttps://boris-portal.unibe.ch/handle/20.500.12422/45632
dc.language.isoen
dc.publisherWiley-Blackwell
dc.relation.ispartofJournal of the American Geriatrics Society
dc.relation.issn0002-8614
dc.relation.organizationDCD5A442C058E17DE0405C82790C4DE2
dc.relation.organizationDCD5A442BDB9E17DE0405C82790C4DE2
dc.relation.organizationClinic of General Internal Medicine
dc.subjectVeterans cardiovascular event deintensification elderly fall injury hypertension intensification syncope treatment
dc.subject.ddc600 - Technology::610 - Medicine & health
dc.subject.ddc300 - Social sciences, sociology & anthropology::360 - Social problems & social services
dc.titleClinical outcomes of modifying hypertension treatment intensity in older adults treated to low blood pressure.
dc.typearticle
dspace.entity.typePublication
oaire.citation.endPage2841
oaire.citation.issue10
oaire.citation.startPage2831
oaire.citation.volume69
oairecerif.author.affiliationBerner Institut für Hausarztmedizin (BIHAM)
oairecerif.author.affiliationBerner Institut für Hausarztmedizin (BIHAM)
oairecerif.author.affiliation2Universitätsklinik für Allgemeine Innere Medizin
oairecerif.author.affiliation2Clinic of General Internal Medicine
unibe.contributor.rolecreator
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unibe.date.licenseChanged2021-10-14 17:33:28
unibe.description.ispublishedpub
unibe.eprints.legacyId156885
unibe.journal.abbrevTitleJ AM GERIATR SOC
unibe.refereedtrue
unibe.subtype.articlejournal

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