Intensifying Antihypertensives After Discharge Linked to Worse Outcomes

Intensifying antihypertensive therapy at discharge does not appear to reduce the risk of cardiac events in adults who are hospitalized for noncardiac conditions, and in fact may be associated with an increased risk of readmission, according to the results of a recent study.

Transient blood pressure (BP) elevation is common in hospitalized older adults and often leads to prescription of intensive antihypertensive therapy at discharge, according to the researchers.

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In order to examine the effects of this intensification on clinical outcomes, they conducted a retrospective cohort study of patients aged 65 years and older with hypertension who had been hospitalized from January 1, 2011 to December 31, 2013 with noncardiac conditions.

The study included 4056 adults (mean age 77 years), half of whom received antihypertensive intensification and half who did not. Those who received intensifications had a higher risk of readmission within 30 days (hazard ratio [HR] 1.23) as well as serious adverse events (HR 1.41). Among patients who did not receive intensification, no difference was found in cardiovascular events (HR 1.18) or change in systolic BP at 1 year.

“Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days,” they concluded.

—Michael Potts

Reference:

Anderson TS, Jing B, Auerbach A, et al. Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge [published online August 19, 2019] JAMA Intern Med. doi:10.1001/jamainternmed.2019.3007.