Hypertension Treatment and Outcomes in US Nursing Homes: Results From the US National Nursing Home Survey

Objectives: The objective of this study was to describe antihypertensive medication use, determine what effects comorbid illness has on prescribing of commonly used antihypertensive medications, and explore how treatment affected selected clinical and functional outcomes in US nursing home residents. Design: Cross-sectional observational study using data from the 2004 National Nursing Home Survey, a nationally representative sample of US nursing home residents. Results: More than one half, 53.8%, of all residents had hypertension as a primary admission or current diagnosis. A large majority (84%) of residents with the diagnosis of hypertension were receiving at least one legend medication indicated for hypertension. The most common selection of pharmacologic agent was monotherapy with diuretics in 11% of all residents receiving antihypertensive medications. Hypertensive residents with a diagnosis of arrhythmia (odds ratio [OR] = 1.19, 95% confidence interval [Cl] = 1.02-1.38), stroke (OR = 1.18, 95% Cl = 1.05-1.34), or heart failure (OR = 1.17, 95% Cl = 1.04-1.32) were more likely to be receiving a beta blocker. Those with diabetes (OR = 0.86, 95% Cl = 0.77-0.96), depression (OR = 0.78, 95% Cl = 0.70-0.87), constipation (OR = 0.72, 95% Cl = 0.61-0.84), or asthma (OR = 0.51, 95% Cl = 0.34-0.74) were less likely to be receiving a beta blocker. Hospital admission was less likely (OR = 0.50, 95% Cl = 0.36-0.69) when residents were taking any commonly used antihypertensive medication (diuretics, beta blockers, angiotensin-converting enzyme/angiotensin receptor blockers [ACE/ARBs], calcium channel blockers, or alpha-blockers) but significantly more likely when therapy included a beta blocker (OR = 1.45, 95% Cl = 1.18 - 1.78). Beta blockers were associated with an increased likelihood of falls (OR = 1.14, 95% Cl = 1.04-1.27) and a decreased likelihood of constipation (OR 0.72, 95% Cl = 0.61-0.84). Beta blockers were associated with a decreased likelihood of depression (OR 0.83, 95% Cl = 0.74-0.92) as was the use of any commonly used antihypertensive (OR = 0.76, 95% Cl = 0.63-0.90). Conclusion: Hypertension is prevalent in US nursing home residents and most residents with that diagnosis (84%) are being treated with antihypertensive medication. Through examination of the National Nursing Home Survey database, associations between the use of selected antihypertensive medication, cormorbid illness, and specified outcomes were observed. (J Am Med Dir Assoc 2011; 12: 44-49)