{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T06:05:08Z","timestamp":1785045908973,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,10,23]],"date-time":"2018-10-23T00:00:00Z","timestamp":1540252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30 AG028741"],"award-info":[{"award-number":["P30 AG028741"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001080","name":"Patrick and Catherine Weldon Donaghue Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001080","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the relationship between antihypertensive drug deintensification and recurrent falls in long\u2010term care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Settings<\/jats:title><jats:p>Department of Veterans Affairs (<jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>) inpatient, outpatient, and purchased care data, Minimum Data Set assessments from <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> nursing homes (NHs), and Medicare claims from fiscal years 2010 \u2013 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We identified <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content> residents with evidence of overaggressive antihypertensive treatment, defined as systolic blood pressure (<jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content>) 80\u2013120 and an index fall. Recurrent fall, hospitalization, and mortality within 30\u00a0days were compared between veterans whose antihypertensive medications were deintensified versus those whose antihypertensive medications were not using propensity score methods (<jats:styled-content style=\"fixed-case\">PSM<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Among 2,212 <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content> residents with possibly overaggressive antihypertensive treatment, 11 percent experienced antihypertensive drug deintensification. Lower blood pressure, &gt;1 antihypertensive drug, no congestive heart failure, fracture from index fall, and older age were associated with higher likelihood of deintensification. Antihypertensive deintensification was associated with statistically significant (<jats:italic>p<\/jats:italic>\u2010value\u00a0&lt;\u00a0.01) lower risk of recurrent fall among residents with <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> 80\u2013100 (marginal effect = \u221211.4 percent; <jats:styled-content style=\"fixed-case\">PSM<\/jats:styled-content> = \u221213.6 percent) and higher risk of death among residents with <jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> 101\u2013120 (marginal effect = 2.1 percent, <jats:italic>p<\/jats:italic>\u2010value = .07; with <jats:styled-content style=\"fixed-case\">PSM<\/jats:styled-content> = 4.3 percent, <jats:italic>p<\/jats:italic>\u2010value = .04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Results provide some needed evidence and guidelines for deintensifying antihypertensive medication among frail older residents; since hypertension is prevalent among 54 percent of <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content> residents, the potential impact of new evidence is great.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13074","type":"journal-article","created":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T03:43:27Z","timestamp":1540352607000},"page":"4066-4086","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Antihypertensive Drug Deintensification and Recurrent Falls in Long\u2010Term Care"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4415-5074","authenticated-orcid":false,"given":"Wei","family":"Song","sequence":"first","affiliation":[{"name":"VA Central Office Geriatrics &amp; Extended Care Data &amp; Analysis Center (GECDAC) Washington DC"},{"name":"Department of Public Health Sciences University of Rochester School of Medicine and Dentistry Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orna","family":"Intrator","sequence":"additional","affiliation":[{"name":"VA Central Office Geriatrics &amp; Extended Care Data &amp; Analysis Center (GECDAC) Washington DC"},{"name":"Department of Public Health Sciences University of Rochester School of Medicine and Dentistry Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei","family":"Lee","sequence":"additional","affiliation":[{"name":"San Francisco VA Health Care System and University of California San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1165-5558","authenticated-orcid":false,"given":"Kenneth","family":"Boockvar","sequence":"additional","affiliation":[{"name":"James J. 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