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dc.contributor.authorGulla, Christineen_US
dc.contributor.authorFlo, Elisabethen_US
dc.contributor.authorKjome, Reidun L. S.en_US
dc.contributor.authorHusebø, Bettinaen_US
dc.description.abstractBackground: It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods: From August 2014 to December 2015, 765 patients from 72 units (clusters) in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment (n = 295, 39%) were randomized to systematic medication review where the physician received support from peers (collegial mentoring) or were given care as usual (control condition). Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results: At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group (n = 43, 32%) compared to control (n = 11, 10%); Incidence Rate Ratio = 0.8, 95% CI = 0.7-0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values (mean 134 mmHg). Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four (P = 0.031) and nine (P = 0.041). Conclusion: A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.en_US
dc.publisherScience Presseng
dc.relation.ispartof<a href="" target="blank">A Fine Balance: Drug Use in Norwegian Nursing Homes</a>
dc.rightsAttribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0)eng
dc.subjectAntihypertensive drugseng
dc.subjectLong-term careeng
dc.subjectMedication revieweng
dc.titleDeprescribing antihypertensive treatment in nursing home patients and the effect on blood pressureen_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright Journal of Geriatric Cardiology.
dc.source.journalJournal of Geriatric Cardiology
dc.subject.nsiVDP::Medisinske Fag: 700::Helsefag: 800en_US

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Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0)
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0)