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