Increased readmissions and adverse events with intensification of antihypertensive regimen on hospital discharge

Reference

Anderson TS, Jing B, Auerbach A, et al. Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge. JAMA Intern Med 2019 Aug 19. [Epub ahead of print]

Synopsis

Using national data from the Veterans Health Administration, these investigators identified adults 65 years or older with hypertension who were admitted within a 2-year period to a Veterans Affairs (VA) hospital for the common noncardiac conditions of pneumonia, urinary tract infection, or venous thromboembolism. Patients with a secondary diagnosis of atrial fibrillation, acute coronary syndrome, or acute cerebrovascular event were excluded. Using dispensing data from the VA hospital pharmacies, intensifications of antihypertensive regimens were identified by newly prescribed antihypertensive medications on discharge, or an increased dose by more than 20% of a medication that had been prescribed prior to admission. Patients who received more than 20% of their outpatient care outside the VA, patients admitted from nursing homes, and those who had been hospitalized within the last 30 days were excluded. Out of an initial cohort of 14,915 patients, of which 97% were male, 2074 (14%) had antihypertensive regimen intensifications at discharge. These patients were more likely to be black and more likely to have higher pre-hospitalization blood pressures, higher inpatient blood pressures, and heart failure. Using propensity score matching, the investigators then compared 2028 patients who had antihypertensive regimen intensifications with 2028 similar patients without such intensifications. Those with intensification were more likely to be readmitted within 30 days of discharge (21% vs 18%; hazard ratio [HR] 1.23; 95% CI 1.07 - 1.42) and were more likely to have an emergency department visit or hospitalization for a medication-related serious adverse event within 30 days (4.5% vs. 3.1%; HR 1.41; 1.06 - 1.88). There was no difference between the 2 groups in the rate of cardiovascular events (defined as a composite of emergency department visits and hospitalizations for acute myocardial infarction, unstable angina, stroke, heart failure, or hypertension) at 1 year.