Table 2.
Rates of antihypertensive intensification in older adults after hospital admission, by inpatient and outpatient blood pressures
| Blood pressure category | Intensification, No (%) | Odds ratio (95% CI) | |
|---|---|---|---|
| Unadjusted | Adjusted | ||
| Overall cohort (n=14 915) | 2074 (13.9) | ||
| Outpatient blood pressure*: | |||
| Well controlled (n=9636) | 1082 (11.2) | 1 (reference) | 1 (reference) |
| High (n=4567) | 826 (18.1) | 1.75 (1.58 to 1.93) | 1.25 (1.08 to 1.45) |
| Very high (n=287) | 92 (32.1) | 3.73 (2.89 to 4.82) | 3.28 (2.09 to 5.14) |
| Inpatient blood pressure†: | |||
| Not elevated (n=11 218) | 985 (8.8) | 1 (reference) | 1 (reference) |
| Moderately elevated (n=2755) | 718 (26.1) | 3.66 (3.29 to 4.08) | 3.54 (3.03 to 4.12) |
| Severely elevated (n=775) | 349 (45.0) | 8.51 (7.28 to 9.95) | 7.67 (5.91 to 9.95) |
Adjusted odds ratios estimated using mixed effect logistic regression accounting for age category, sex, ethnicity, income, Charlson comorbidity index, length of stay, primary discharge diagnosis, year, hospital training status, inpatient blood pressure (BP), outpatient BP, an interaction term for inpatient and outpatient BP, and random effects to account for clustering by Veterans Affairs hospital.
Outpatient BP control measured using median of three outpatient BPs before admission and defined as well controlled if systolic blood pressure (SBP)<140 mm Hg, high if SBP 140-179 mm Hg or diastolic blood pressure (DBP) 90-100 mm Hg, or very high if SBP≥180 mm Hg or DBP>100 mm Hg.
Inpatient BP control defined by number of elevated BP recordings and defined as severely elevated if ≥3 recordings of SBP>180 mm Hg, moderately elevated if ≥3 recordings of SBP>160 mm Hg without meeting criteria for severely elevated, or not elevated.