Trends in blood pressure diagnosis, treatment, and control among VA nursing home residents, 2007–2018.

Background: Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. Methods: Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long‐term care residents aged ≥65 years from October 2006 through September 2018 (FY2007‐2018). Hypertension prevalence at admission was identified by ICD code(s) in the year prior, and antihypertensive medication use was defined as administration ≥50% of days. BP measures were averaged over 2‐year epochs. Results: The age‐standardized prevalence of hypertension diagnosis at admission increased from 75.2% in FY2007‐2008 to 85.1% in FY2017‐2018 (p‐value for trend <0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (p‐values for trend <0.001) but remained high (80.3% treated in FY2017‐2018, 80.1% with average BP <140/90 mmHg). The age‐adjusted prevalence of chronic low BP (average <90/60 mmHg) also declined from 11.1% in FY2007‐2008 to 4.7% in FY2017‐2018 (p‐value for trend <0.001). Persons identified as Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have an average BP <140/90 mmHg. Conclusions: Hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by a lower prevalence of chronic low BP. Nonetheless, some high‐risk populations have average BP levels >140/90 mmHg. Future research is needed to better understand the benefits and harms of BP control in nursing home residents. [ABSTRACT FROM AUTHOR]