Hypotension in Nursing Home Residents on Antihypertensive Treatment: Is it Associated with Mortality?



      To assess whether low systolic blood pressure (SBP) or diastolic blood pressure (DBP) due to antihypertensive medications might be related to mortality among nursing home (NH) residents.


      Observational, longitudinal.


      Nursing home.


      Age ≥60 years, receiving antihypertensive medications.


      Demographic characteristics, mobility status, number of chronic diseases and drugs, nutritional status, and antihypertensive medications were noted. At the first visit, we recorded blood pressure (BP) measurements of last 1 year, which were measured regularly at 2-week intervals and considered their mean values. SBP and DBP thresholds were analyzed for mortality by ROC analysis. Multivariate Cox regression analyses were performed to determine factors related to mortality.


      The sample included 253 residents with a mean age of 75.7 ± 8.7 years, and 66% were male. Residents were evaluated at a mean follow-up time of 14.3 ± 5.2 months (median: 15) for short-term mortality and 31.6 ± 14.3 months (median: 40) for long-term mortality. The prevalence of low SBP (≤110 mm Hg) and low DBP (≤65 mm Hg) was 34.8% and 15.8%, respectively. In follow-up, the short-term mortality rate was 21.7% (n = 55) and the long-term mortality rate was 42.2% (n = 107). Low SBP (≤110 mm Hg) was related to mortality in short- and long-term follow-ups [short-term follow-up: hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.5-8.6, P = .01; long-term follow-up: HR 1.8, 95% CI 1.1-3.0, P = .02], adjusted for age, mobility status, nutritional state, and total number of diseases and drugs. Low DBP (≤65 mm Hg) was related to mortality in short- and long-term follow-ups [short-term follow-up: HR 3.0, 95% CI 1.2-7.8, P = .02, long-term follow-up: HR 2.8, 95% CI 1.5-5.2, P = .001], adjusted for age, mobility status, nutritional state, and total number of diseases and drugs.

      Conclusions and Implications

      Systolic hypotension was found in more than one-third of the NH residents receiving antihypertensive treatment. Low SBP and DBP were significant factors associated with mortality. Particular attention should be paid to prevent low SBP and DBP in NH residents on antihypertensive treatment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Burt V.L.
        • Whelton P.
        • Roccella E.J.
        • et al.
        Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991.
        Hypertension. 1995; 25: 305-313
        • Vasan R.S.
        • Beiser A.
        • Seshadri S.
        • et al.
        Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.
        JAMA. 2002; 287: 1003-1010
        • Pinto E.
        Blood pressure and ageing.
        Postgrad Med J. 2007; 83: 109-114
        • Moser M.
        Historical perspectives on the management of hypertension.
        J Clin Hypertens (Greenwich). 2006; 8 (quiz 39): 15-20
        • Briasoulis A.
        • Agarwal V.
        • Tousoulis D.
        • Stefanadis C.
        Effects of antihypertensive treatment in patients over 65 years of age: A meta-analysis of randomised controlled studies.
        Heart. 2014; 100: 317-323
        • Charlesworth C.J.
        • Smit E.
        • Lee D.S.
        • et al.
        Polypharmacy among adults aged 65 years and older in the United States: 1988-2010.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 989-995
        • Mallet L.
        • Spinewine A.
        • Huang A.
        The challenge of managing drug interactions in elderly people.
        Lancet. 2007; 370: 185-191
        • Peralta C.A.
        • Katz R.
        • Newman A.B.
        • et al.
        Systolic and diastolic blood pressure, incident cardiovascular events, and death in elderly persons: The role of functional limitation in the Cardiovascular Health Study.
        Hypertension. 2014; 64: 472-480
        • Odden M.C.
        • Peralta C.A.
        • Haan M.N.
        • Covinsky K.E.
        Rethinking the association of high blood pressure with mortality in elderly adults: The impact of frailty.
        Arch Intern Med. 2012; 172: 1162-1168
        • Odden M.C.
        • Covinsky K.E.
        • Neuhaus J.M.
        • et al.
        The association of blood pressure and mortality differs by self-reported walking speed in older Latinos.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 977-983
        • Tinetti M.E.
        • Han L.
        • Lee D.S.
        • et al.
        Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults.
        JAMA Intern Med. 2014; 174: 588-595
        • Charlesworth C.J.
        • Peralta C.A.
        • Odden M.C.
        Functional status and antihypertensive therapy in older adults: A new perspective on old data.
        Am J Hypertens. 2016; 29: 690-695
        • Gutierrez-Misis A.
        • Sanchez-Santos M.T.
        • Banegas J.R.
        • et al.
        Walking speed and high blood pressure mortality risk in a Spanish elderly population.
        J Hum Hypertens. 2015; 29: 566-572
        • James P.A.
        • Oparil S.
        • Carter B.L.
        • et al.
        2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
        JAMA. 2014; 311: 507-520
        • Mancia G.
        • Fagard R.
        • Narkiewicz K.
        • et al.
        2013 ESH/ESC practice guidelines for the management of arterial hypertension.
        Blood Press. 2014; 23: 3-16
        • Wright Jr., J.T.
        • Williamson J.D.
        • Whelton P.K.
        • et al.
        A randomized trial of intensive versus standard blood-pressure control.
        N Engl J Med. 2015; 373: 2103-2116
        • Williamson J.D.
        • Supiano M.A.
        • Applegate W.B.
        • et al.
        Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: A randomized clinical trial.
        JAMA. 2016; 315: 2673-2682
        • Vellas B.
        • Guigoz Y.
        • Garry P.J.
        • et al.
        The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.
        Nutrition. 1999; 15: 116-122
        • Bulpitt C.J.
        • Fletcher A.E.
        • Amery A.
        • et al.
        The Hypertension in the Very Elderly Trial (HYVET). Rationale, methodology and comparison with previous trials.
        Drugs Aging. 1994; 5: 171-183
        • Kojima G.
        • Liljas A.E.M.
        • Iliffe S.
        Frailty syndrome: Implications and challenges for health care policy.
        Risk Manag Healthc Policy. 2019; 12: 23-30
        • Benetos A.
        • Bulpitt C.J.
        • Petrovic M.
        • et al.
        An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects.
        Hypertension. 2016; 67: 820-825
        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        Circulation. 2018; 138: e426-e483
        • Williams B.
        • Mancia G.
        • Spiering W.
        • et al.
        2018 ESC/ESH Guidelines for the management of arterial hypertension.
        Eur Heart J. 2018; 39: 3021-3104
        • Bahat G.
        • İlhan B.
        • Tufan A.
        • Karan M.A.
        Blood pressure goals in functionally limited elderly patients.
        Am J Med. 2017; 130: e319-e320
        • Warwick J.
        • Falaschetti E.
        • Rockwood K.
        • et al.
        No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: An investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over.
        BMC Med. 2015; 13: 78
        • Cesari M.
        • Gambassi G.
        • Abellan van Kan G.
        • Vellas B.
        The frailty phenotype and the frailty index: Different instruments for different purposes.
        Age Ageing. 2013; 43: 10-12
        • Benetos A.
        • Labat C.
        • Rossignol P.
        • et al.
        Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: The PARTAGE Study.
        JAMA Intern Med. 2015; 175: 989-995
        • Streit S.
        • Poortvliet R.K.E.
        • Gussekloo J.
        Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-Plus Study.
        Age Ageing. 2018; 47: 545-550

      Related Podcast

      November 17, 2021

      November 2021 Issue: Orthostatic Hypotension / Young Nursing Home Residents, COVID Vaccine Adverse Events

      Featuring Dr. Philip Sloane, Dr. Mallory Brown; Recorded: November 18, 2021.

      Loading ...