AAT-Falls: Adherence to antihypertensive therapeutic guidelines and association with falls in a long-term care facility

Introduction: Hypertension is a prevalent condition in the aging population. Joint National Committee (JNC)-8 guidelines recommend a blood pressure goal of <150/90 mmHg for patients over 60 years. Preliminary data from the SPRINT trial suggests benefits with a more stringent systolic blood pressure goal (120 mmHg) for patients over 50 years.  The influence of blood pressure on falls in older patients is an important consideration that requires further evaluation of blood pressure treatment goals in this population.

Objectives: To compare blood pressure goals for patients with hypertension in a skilled nursing home setting to current JNC 8 clinical practice guidelines and to investigate the relationship between treatment goals and falls prevalence.

Study Design: Retrospective, observational cohort using electronic medical records

Methods: Data was sampled from patients who received treatment for hypertension between January 1 and June 30, 2014. Demographic and clinical data was collected, including age, renal function, comorbid diagnoses, mean systolic and diastolic blood pressures, antihypertensive medications and the presence of hold parameters. Adherence to JNC-8 guidelines and the correlation of blood pressure and falls will be described using descriptive and nonparametric statistics.

Results: Ninety patients were included in the analysis. Fifty-three percent of patients were ≥85 years old. Hold parameters were identified in only 11% of patients. Ninety-five percent of patients (n=86) met JNC-8 goals with an average measured blood pressure ≤150/90 and accounted for all 45 documented falls. No falls were documented among patients with hold parameters. However, mean systolic blood pressure did not differ between patients with and without hold parameters (124 vs. 126 mmHg, p=0.695).

Conclusions: In older patients, hold parameters for antihypertensive medications may prove useful. The effect of this intervention on falls reductions is unknown. Practice guidelines coupled with clinical judgement are needed to establish appropriate blood pressure goals in the aging population.