Antihypertensive Deprescribing and Functional Status in VA Long-Term Care Residents With and Without Dementia

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-01-03 DOI:10.1111/jgs.19342

Xiaojuan Liu, Laura A. Graham, Bocheng Jing, Chintan V. Dave, Yongmei Li, Manjula Kurella Tamura, Michael A. Steinman, Sei J. Lee, Christine K. Liu, Hoda S. Abdel Magid, Veena Manja, Kathy Fung, Michelle C. Odden

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引用次数: 0

Abstract

Background

Deprescribing antihypertensives is of growing interest in geriatric medicine, yet the impact on functional status is unknown. We emulated a target trial of deprescribing antihypertensive medications compared with continued use on functional status measured by activities of daily living (ADL) in a long-term care population.

Methods

We included 12,238 Veteran Affairs long-term care residents age 65+ who had a stay ≥ 12 weeks between 2006 and 2019. After 4+ weeks of stable antihypertensive medication use, residents were classified as either deprescribed antihypertensives (reduced ≥ 1 medication or ≥ 30% dose) or continued users. Residents were followed up for 2 years, or censored at discharge, admission to hospice, protocol deviation (per-protocol analysis only), or Sept 30, 2019. The outcome was ADL dependencies (scored 0–28; higher score = worse functionality), assessed approximately every 3 months. Our primary approach was to estimate per-protocol effects using linear mixed-effects regressions with inverse probability of treatment and censoring weighting, overall and stratified by dementia status. We estimated intention-to-treat effects as a secondary analysis.

Results

In long-term care residents, ADL scores worsened by a mean of 0.29 points (95%CI = 0.27, 0.31) per 3 months and antihypertensive deprescribing did not impact this worsening (difference between groups −0.04 points every 3 months, 95%CI = −0.15, 0.06). In the non-dementia subgroup, ADL worsened by 0.15 points (95%CI = 0.11, 0.19) every 3 months. However, residents who were deprescribed showed a slightly improved ADL score over time while the continued users showed ADL decline (difference between groups −0.23 points every 3 months, 95%CI = −0.43, −0.03). Deprescribing was not associated with ADL change in the dementia subgroup. The intention-to-treat results were not meaningfully different.

Conclusions

Antihypertensive deprescribing did not have a deleterious effect on functional status in long-term care residents with or without dementia. This may be reassuring to residents and clinicians who are considering antihypertensive medication reduction or discontinuation in long-term care settings.

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有和没有痴呆的VA长期护理居民的降压处方和功能状况。

背景：降压药处方在老年医学中越来越受到关注，但其对功能状态的影响尚不清楚。我们模拟了一项目标试验，在长期护理人群中，通过日常生活活动（ADL）测量功能状态，将处方降压药与持续使用降压药进行比较。方法：我们纳入了12238名65岁以上的退伍军人事务长期护理居民，他们在2006年至2019年期间住院≥12周。在稳定使用降压药4周以上后，居民被分类为非处方降压药（减少≥1种药物或剂量≥30%）或继续使用降压药。住院患者随访2年，或在出院、入住临终关怀、协议偏差（仅按协议分析）或2019年9月30日进行审查。结果是ADL依赖性(0-28分；得分越高=功能越差)，大约每3个月评估一次。我们的主要方法是使用线性混合效应回归来估计每个方案的效果，该回归具有治疗的逆概率，并根据痴呆状态进行总体和分层。我们估计意向治疗效应作为次要分析。结果：在长期护理居民中，ADL评分每3个月平均恶化0.29分（95%CI = 0.27, 0.31），抗高血压处方对这种恶化没有影响（组间差异为每3个月-0.04分，95%CI = -0.15, 0.06）。在非痴呆亚组中，ADL每3个月恶化0.15点（95%CI = 0.11, 0.19）。然而，随着时间的推移，停用药物的居民的ADL评分略有提高，而继续使用药物的居民的ADL评分则有所下降（组间差异为每3个月-0.23分，95%CI = -0.43, -0.03）。在痴呆亚组中，开处方与ADL变化无关。意向治疗结果没有显著差异。结论：抗高血压处方对患有或不患有痴呆症的长期护理居民的功能状态没有有害影响。这对于考虑在长期护理环境中减少或停用降压药的居民和临床医生来说可能是一种安慰。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.