Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Faculty of Medicine, University Hospital in Kraków, Kraków, Poland
Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
Pol Arch Intern Med. 2021 May 25;131(5):439-446. doi: 10.20452/pamw.15944. Epub 2021 Apr 20.
Long-term care facility (LTCF) residents are typically excluded from clinical trials due to multimorbidity, dementia, and frailty, so there are no clear evidence-based rules for treating arterial hypertension in this population. Moreover, the role of hypertension as mortality risk factor in LTCFs has not yet been clearly established.
The study aimed to investigate whether treated hypertension is associated with lower mortality among older LTCF residents with multimorbidity.
The study was performed in a group of 168 residents aged ≥ 65 years in three LTCFs. Initial assessment included blood pressure (BP) measurements and selected geriatric scales: MNA-SF, AMTS and ADL. Hypertension, comorbidities, pharmacotherapy, antihypertensive drugs and mortality during one-year follow-up were extracted from the medical records. The data was compared in groups: Survivors and Deceased.
Survivors and Deceased revealed similar age, DBP, number of diseases, medications, and antihypertensive drugs. However, Deceased had significantly lower SBP (P <0.05) and presented significantly worse functional, nutritional and cognitive status than Survivors (P <0.001). Hypertension (P <0.001) and antihypertensive therapy (P <0.05) were significantly more frequent among Survivors. Significantly more of the hypertensive-treated than other multimorbid residents survived the follow-up (P <0.001). Logistic regression analysis showed that treated hypertension had a protective effect on mortality [OR = 0.11 (95% CI, 0.03-0.39); P <0.001].
One-year survival of LTCF residents with treated hypertension was significantly higher than the others. Appropriate antihypertensive therapy may be a protective factor against death in frail nursing home residents, even in short period of time.
长期护理机构（LTCF）的居民通常由于多病共存、痴呆和虚弱而被排除在临床试验之外，因此，针对这一人群的动脉高血压治疗没有明确的循证规则。此外，高血压作为 LTCF 死亡率的危险因素尚未得到明确证实。
本研究旨在调查多病共存的老年 LTCF 居民中，接受治疗的高血压是否与较低的死亡率相关。
该研究在三个 LTCF 中的 168 名年龄≥65 岁的居民中进行。初始评估包括血压（BP）测量和选定的老年量表：MNA-SF、AMTS 和 ADL。从病历中提取高血压、合并症、药物治疗、抗高血压药物和一年随访期间的死亡率。将数据在存活组和死亡组之间进行比较。
存活组和死亡组的年龄、舒张压、疾病数量、药物和抗高血压药物相似。然而，死亡组的收缩压明显较低（P <0.05），且功能、营养和认知状态明显差于存活组（P <0.001）。存活组的高血压（P <0.001）和抗高血压治疗（P <0.05）更为常见。与其他多病共存的居民相比，接受高血压治疗的患者在随访中存活的比例显著更高（P <0.001）。逻辑回归分析显示，接受治疗的高血压对死亡率有保护作用[比值比（OR）=0.11（95%置信区间，0.03-0.39）；P <0.001]。
接受治疗的高血压的 LTCF 居民的一年生存率明显高于其他患者。适当的抗高血压治疗可能是体弱护理院居民死亡的保护因素，即使在短时间内也是如此。
