Key result
Guideline-suggested minimum treatment for hypertension at hospital discharge was associated with a 40% lower risk of hospitalization or all-cause death (OR 0.60) in older patients.
Why the study?
Hypertension management in older patients is challenging, particularly during hospitalization, prompting investigation into the determinants and outcomes of antihypertensive drug prescription in this population.
Does guideline-suggested minimum treatment for hypertension at discharge reduce adverse clinical outcomes in older hospitalized patients?
Observational (n=5,671)
Yes
Does guideline-suggested minimum treatment for hypertension at discharge reduce adverse clinical outcomes in older hospitalized patients?
Odds Ratio: 0.6 (95% CI 0.49–0.75)
p-value: p=<0.001
Maintaining guideline-directed minimum antihypertensive treatment at hospital discharge in older patients is associated with significantly reduced mortality and rehospitalization.
Hypothesis-generating for maintaining guideline-minimum therapy at discharge; prospective trials needed before changing deprescribing practice.
BACKGROUND: Hypertension management in older patients represents a challenge, particularly when hospitalized. OBJECTIVE: The objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients. METHODS: A total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptor-blocker (ARB) with a calcium-channel-blocker (CCB) and/or a thiazide diuretic; if >80 years old, an ACE-I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all-cause death, cardiovascular (CV) hospitalization/death, CV death, non-CV death, evaluated according to the presence of MT at discharge. RESULTS: Hypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all-cause death, all-cause death/hospitalization, CV death, CV death/hospitalization and non-CV death. CONCLUSIONS: Guidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in antihypertensive treatment still occur in a significant proportion of older hospitalized patients.
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Cicco et al. (2022) conducted an observational in Hypertension (n=5,671). Guideline-suggested minimum treatment for hypertension at discharge vs. No minimum treatment for hypertension at discharge was evaluated on Hospitalization or all-cause death (OR 0.60, 95% CI 0.49-0.75, p=<0.001). Guideline-suggested minimum treatment for hypertension at hospital discharge was associated with a 40% lower risk of hospitalization or all-cause death (OR 0.60) in older patients.
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