Abstract 057: Trends In Blood Pressure Diagnosis, Treatment, And Control Among Nursing Home Residents, 2007-2018

Abstract

Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. In this study, we describe the prevalence, pharmacologic treatment, and control of hypertension over time among older adults residing in Veterans Affairs (VA) nursing homes from October 2006 through September 2018 (FY2007-2018). Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long-term care residents aged 65 years and older. Hypertension prevalence at admission was identified by one or more ICD code(s) in the year prior, and antihypertensive medication use was considered present if administered ≥50% of days in the nursing home. BP measures were obtained from the electronic health record and averaged over 2 year epochs. The age-standardized prevalence of hypertension diagnosis at admission increased over time from 75.2% in FY2007-2008 to 85.1% in FY2017-2018 (p-value for trend <0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (all p-values for trend <0.001), but remained high (80.3% of residents treated in FY2017-2018 and 80.1% with average BP <140/90 mmHg). (Figure) The age-adjusted prevalence of chronic low BP, defined as average BP <90/60 mmHg, also declined over this period from 11.1% in FY2007-2008 to 4.7% in FY2017-2018 (p-value for trend <0.001). Persons identified in their health records as being of Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have average BP <140/90 mmHg. In summary, hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by lower prevalence of chronic low BP. Nonetheless, some high-risk populations have average BP levels >140/90 mmHg. Future research is needed to better understand the ratio of benefits to harms of BP control in nursing home residents.