OBJECTIVES To assess how often older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment, and to identify markers of appropriateness for these intensifications. DESIGN Retrospective cohort study. SETTING US Veterans Administration Health System. PARTICIPANTS Patients aged 65 years or over with hypertension admitted to hospital with non-cardiac conditions between 2011 and 2013. MAIN OUTCOME MEASURES Intensification of antihypertensive treatment, defined as receiving a new or higher dose antihypertensive agent at discharge compared with drugs used before admission. Hierarchical logistic regression analyses were used to control for characteristics of patients and hospitals. RESULTS Among 14 915 older adults (median age 76, interquartile range 69-84), 9636 (65%) had well controlled outpatient blood pressure before hospital admission. Overall, 2074 (14%) patients were discharged with intensified antihypertensive treatment, more than half of whom (1082) had well controlled blood pressure before admission. After adjustment for potential confounders, elevated inpatient blood pressure was strongly associated with being discharged on intensified antihypertensive regimens. Among patients with previously well controlled outpatient blood pressure, 8% (95% confidence interval 7% to 9%) of patients without elevated inpatient blood pressure, 24% (21% to 26%) of patients with moderately elevated inpatient blood pressure, and 40% (34% to 46%) of patients with severely elevated inpatient blood pressure were discharged with intensified antihypertensive regimens. No differences were seen in rates of intensification among patients least likely to benefit from tight blood pressure control (limited life expectancy, dementia, or metastatic malignancy), nor in those most likely to benefit (history of myocardial infarction, cerebrovascular disease, or renal disease). CONCLUSIONS One in seven older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment. More than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home.

中文翻译：

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加强老年人出院时的门诊血压治疗：全国回顾性队列研究。

目标 评估因常见非心脏疾病入院的老年人在强化抗高血压治疗后出院的频率，并确定这些强化治疗的适当性标志。设计回顾性队列研究。设置美国退伍军人管理局卫生系统。参与者 2011 年至 2013 年间因非心脏疾病入院的 65 岁或以上的高血压患者。主要观察指标 抗高血压治疗的强化，定义为与入院前使用的药物相比，出院时接受新的或更高剂量的抗高血压药物。分层逻辑回归分析用于控制患者和医院的特征。结果 在 14 915 名老年人（中位年龄 76 岁，四分位数范围 69-84 岁）中，9636 (65%) 人入院前门诊血压控制良好。总体而言，2074 名 (14%) 患者出院时接受强化降压治疗，其中一半以上 (1082) 入院前血压控制良好。调整潜在的混杂因素后，住院患者血压升高与出院时接受强化降压治疗密切相关。在先前门诊血压控制良好的患者中，8%（95% 置信区间 7% 至 9%）的患者住院血压没有升高，24%（21% 至 26%）的患者住院血压中度升高，以及40%（34% 至 46%）的住院血压严重升高的患者在出院时接受强化降压治疗。在最不可能从严格的血压控制中获益的患者（有限的预期寿命、痴呆或转移性恶性肿瘤）和最有可能获益的患者（心肌梗死、脑血管疾病或肾病病史）中，强化率没有差异). 结论 七分之一因常见非心脏疾病入院的老年人在强化抗高血压治疗后出院。超过一半的强化发生在以前门诊血压控制良好的患者中。随着老年人从医院过渡到家中，需要更多关注以减少潜在有害的血压过度治疗。最有可能受益的人（心肌梗塞、脑血管疾病或肾脏疾病的病史）也没有。结论 七分之一因常见非心脏疾病入院的老年人在强化抗高血压治疗后出院。超过一半的强化发生在以前门诊血压控制良好的患者中。随着老年人从医院过渡到家中，需要更多关注以减少潜在有害的血压过度治疗。最有可能受益的人（心肌梗塞、脑血管疾病或肾脏疾病的病史）也没有。结论 七分之一因常见非心脏疾病入院的老年人在强化抗高血压治疗后出院。超过一半的强化发生在以前门诊血压控制良好的患者中。随着老年人从医院过渡到家中，需要更多关注以减少潜在有害的血压过度治疗。超过一半的强化发生在以前门诊血压控制良好的患者中。随着老年人从医院过渡到家中，需要更多关注以减少潜在有害的血压过度治疗。超过一半的强化发生在以前门诊血压控制良好的患者中。随着老年人从医院过渡到家中，需要更多关注以减少潜在有害的血压过度治疗。