BP-lowering medication deprescribing helps preserve cognitive function in nursing home residents

Older nursing home residents who have been deprescribed antihypertensive medications show slower cognitive decline when compared with residents who maintain a stable antihypertensive regimen, as shown in a study.

For the study, researchers applied a target trial emulation approach and included long-term care residents who were at least 65 years of age and had been staying in a nursing facility for at least 12 weeks.

Eligible residents who had been on a stable medication for 4 weeks were classified into deprescribing or stable user groups and followed for 2 years or until death or discharge for the intention-to-treat (ITT) analysis. Participants who switched treatment groups were censored in the per-protocol analysis. Deprescribing was defined as a reduction in the total number of antihypertensive medications or a decrease in medication dosage by 30 percent, sustained for a minimum of 2 weeks.

The main outcome measure was cognitive function, assessed using the Cognitive Function Scale (CFS) and classified as cognitively intact (CFS=1), mildly impaired (CFS=2), moderately impaired (CFS=3), and severely impaired (CFS=4).

Of the 45,183 long-term care residents, 12,644 (mean age 77.7 years, 97.4 percent male) were included in the ITT analysis and 12,053 (mean age 77.7 years, 97.4 percent male) were included in the per-protocol analysis.

At the end of the follow-up, CFS worsened in 12.0 percent of residents and improved in 7.7 percent. Of the residents with worsened CFS score, 10.8 percent were in the deprescribing group and 12.1 percent were in the stable user group.

In the per-protocol analysis, deprescribing was associated with 12-percent lower odds of progressing to a worse CFS category per 12-week period compared with maintaining a stable regimen (odds ratio [OR], 0.88, 95 percent confidence interval [CI], 0.78–0.99).

The association was notably more pronounced among residents with dementia, with deprescribing being associated with 16-percent reduced odds of cognitive decline (OR, 0.84, 95 percent CI, 0.72–0.98).

Results were consistent in the ITT analysis.