Related Experiment Video
Updated: Jun 6, 2025
06:52
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
9.7K
Antihypertensive Deprescribing and Cardiovascular Events Among Long-Term Care Residents
Michelle C Odden1,2, Laura A Graham3, Xiaojuan Liu2
1Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California.
JAMA Network Open
|November 25, 2024
Summary
Deprescribing antihypertensive medications in long-term care residents did not increase the risk of hospitalization for myocardial infarction (MI) or stroke. This finding offers valuable information for clinicians and residents considering medication reduction.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Deprescribing antihypertensive medications is common in long-term care, but its impact on cardiovascular events remains unclear.
- Understanding the risks associated with deprescribing is crucial for patient safety and effective medication management.
Purpose of the Study:
- To compare the incidence of hospitalization for myocardial infarction (MI) or stroke between long-term care residents who underwent deprescribing of antihypertensive medications and those who continued therapy.
Main Methods:
- Utilized target trial emulation with observational electronic health record data from US Department of Veterans Affairs community living centers.
- Included long-term care residents aged 65+ taking antihypertensive medications, analyzing outcomes up to 2 years post-intervention.
- Employed inverse probability of treatment and censoring weighting (IPTW/IPCW) for per-protocol effect estimation.
Main Results:
- Deprescribing antihypertensive medication occurred in 17.8% of 13,096 long-term care residents.
- No significant difference in the cumulative incidence of MI or stroke hospitalization over 2 years was observed between deprescribed and non-deprescribed groups (HR, 0.93; 95% CI, 0.70-1.26).
- Participant characteristics were well-balanced after applying IPTW and IPCW, indicating robust analysis.
Conclusions:
- Deprescribing antihypertensive medication in long-term care residents was not associated with an increased risk of hospitalization for MI or stroke.
- These findings provide evidence to inform clinical decisions regarding antihypertensive medication deprescribing in this population.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
386
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
386
01:23Antihypertensive Drugs: Vasodilators
479
Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
479
01:25Antihypertensive Drugs: Direct Renin Inhibitors
493
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
493
01:28Drug Therapy
39
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
39
01:20Desensitization and Tachyphylaxis
1.5K
Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
1.5K
01:22Heart Failure Drugs: Diuretics
343
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
343