Prior to QMR

• Review the Quarterly Medication Review Deprescribing Focus – Hypertension Management
• Review the resident’s blood pressure trend over the past three months and determine an individualized blood pressure target for the resident:
  • Systolic blood pressure of 150 mmHg or less may be an appropriate target for many LTC residents (see Figure 1, page 3).  Lower blood pressure targets may be appropriate for residents who are younger or have a longer life expectancy than the average LTC resident.
  • Individualize the blood pressure target based on the resident’s goals of care, comorbidities, frailty, and the risk of harms and adverse effects associated with treatment.

During the QMR

• Consider the following reasons to support deprescribing antihypertensives (e.g. decreasing the dose or discontinuing an antihypertensive):
  • Resident is experiencing adverse effects due to antihypertensive medications (see page 6, Table 2 Antihypertensive Adverse Events).
  • Resident has orthostatic hypotension and/or history of falls or is at risk of falls.
  • There has been changes in their renal function that require adjustment of the antihypertensive dose.
  • Resident’s goals of care have changed and/or the resident/family’s preference is for comfort overactive treatment.

• For residents taking multiple antihypertensives, identify if any are being used to treat comorbidities other than hypertension.   Begin with medications being solely used for blood pressure lowering effects or antihypertensive medications not recommended for use in the older population.
• Determine whether the medication needs to be tapered off slowly to avoid rebound hypertension or other adverse effects.
• When discontinuing or decreasing the dose of antihypertensives, regular blood pressure monitoring is recommended.
  • Measure the resident’s blood pressure 1-2 times per week for four weeks after discontinuing or decreasing the dose of the antihypertensive medication, then reassess.