Hypertension or high blood pressure is a disease that affects many people in Kenya.
To effectively manage it, patients are usually given medication that helps to lower the pressure and prevent the disease from damaging body organs.
As per the World Health Organisation (WHO) guidelines, the quantity of medicine recommended for patients is usually determined by their blood pressure levels.
Those with high measurements tend to get higher doses compared to those with lower levels.
Even though this selection process appears to be seemingly straight forward, doctors are urged to be vigilant and exercise caution when making decisions about increasing or lowering drug doses.
This is due to the fact that triggers of elevated blood pressure in those already affected by the disease may be temporary or short-lived.
For instance, older hypertensive patients that are admitted in hospitals tend to have elevated pressure.
As such, it is common practise for doctors to adjust and increase their medication at the time of discharge to allay adverse health outcomes.
A new study published in the JAMA Internal Medicine Journal cautions health practitioners against this treatment approach.
The research, which was conducted by scientists from the University of California San Francisco (UCSF), found that increasing medication for blood pressure when discharging older patients from the hospital may pose a greater risk of falls, fainting and acute kidney injury that outweighs the potential benefits of the elevated doses.
During the study, researchers examined the clinical outcomes of 4,056 veterans with hypertension (65 years and above) who were hospitalised at San Francisco VA Health Care System between January 2011 and December 2013.
They suffered from common, non-cardiac conditions that typically do not require intensified hypertension treatment.
The patients were equally split between those discharged home from the hospital on intensified anti-hypertensive treatment and those who were not.
At 30 days after discharge, veterans on blood pressure medication had a significantly higher risk for readmission to the hospital than patients who did not receive additional drugs.
They also had a higher chance of experiencing medication-related serious adverse events such as falls, fainting and acute kidney injury.
Findings of the study showed that being discharged with intensified anti-hypertensive drugs did not reduce cardiovascular events or improve blood pressure control, a year after discharge.
Instead, it increased the risk for re-admission and serious adverse health outcomes within 30 days after admission.
"Blood pressure management is about long-term control. But during hospitalisation, patients' blood pressure can be temporarily elevated in response to illness and stress," said Dr Timothy Anderson, the lead author of the study and a primary care research fellow in the Division of General Internal Medicine at UCSF.
"Our findings suggest that making medication changes during this period is not beneficial. Instead, deferring medication adjustments to out-patient doctors to consider once patients are recovered from their acute illness is likely to be a safer course."
When patients are admitted, their blood pressure is measured frequently as it usually fluctuates.
Previous research has shown that higher blood pressure due to pain, stress, anxiety and exposure to new medications while in the hospital may lead clinicians to intensify anti-hypertensive treatment.
This may be done without knowledge of other patient factors such as prior medication history, drug intolerance, barriers to medication adherence and long-term success at disease control.
"The goal of starting patients on new blood pressure medication is to reduce their long-term risk of heart attacks, heart failure and strokes. But our findings suggest that the right time to start these medications is not when patients are hospitalised for other conditions," said Dr Michael Steinman, a senior author of the study at UCSF and clinician in the geriatrics clinic and inpatient general medicine service at the San Francisco VA Medical Centre.
The authors recommend that health practitioners should review prior blood pressure measurements and medication records of hospitalised older patients before adjusting their hypertension medicine.
Dr Anderson cautioned that the findings do not apply to people admitted in hospitals for heart conditions, since changing blood pressure medications in such cases may be beneficial.
Also, he stated that the results of the study might not also apply to younger or healthier populations than those assessed in the new study.
"Our study was focused on blood pressure. But medications for other chronic conditions may also be adjusted during hospitalisation with uncertain outcomes."
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