Finding the right balance

Managing blood pressure in aging adults in nursing homes can be tricky. Geriatricians like Dr. Sarah Berry aim for a "sweet spot" where blood pressure isn't so high it leads to a heart attack or stroke, but not so low that it causes dizziness and falls.

She recalls a patient with dementia enrolled in a clinical trial, who had suffered a fracture.

"Her blood pressure was too low, often around 90-100 systolic, so we stopped the medication," said Berry, associate professor of medicine at Harvard University and gerontology division chief at Beth Israel Deaconess Medical Center.

The patient felt less dizzy and fell less often.

"It was powerful evidence to suggest that deprescribing helped her," Berry said.

That same question - when to treat blood pressure more aggressively and when to step back - is driving Daniel Harris' research. Harris, assistant professor of epidemiology at the University of Delaware College of Health Sciences, wants to determine whether more nursing home patients with hypertension, particularly those with Alzheimer's Disease and Related Dementia (ADRD), could benefit from individualized hypertension management.

Harris and co-principal investigator Kaley Hayes, assistant professor of health services, policy and practice at Brown University School of Public Health, have been awarded a $2.6 million grant from the National Institute on Aging (NIA) to evaluate real-world hypertension treatment strategies.

"These residents often get multiple blood pressure checks per day," said Harris. "We want to learn what thresholds drive treatment decisions, how well those decisions align with existing guidelines, and whether nursing home residents need different guidelines."

Harris and Hayes will use data from the Long-Term Care Data Cooperative Electronic Health Record and link it to administrative claims, including doctor visits and hospitalizations.