Episode 8: Rethinking the standard of care for patients with high blood pressure

Andie Cartwright

Hey everyone, welcome back to Better Living Through Data. I’m Andie Cartwright, joined by my always insightful co-host Anthony Pero. Today, we’re diving into blood pressure care in nursing homes—and the way the pandemic turned that world a bit upside down. Anthony, this episode, we’re building on a theme from, gosh, almost every show we’ve done: what happens when real-world events slam into clinical best practices for older adults living with complex conditions.

Anthony Pero

Yeah, and as you know, I'm not a clinician—but I'm a data guy. Looking at the data, it was interesting how quickly routine changed. The study we’re anchoring on today looked at over 140,000 newly admitted nursing home residents with hypertension, both with and without dementia—that’s a huge dataset, thanks to PCC Life Sciences' EHRs. The study followed these residents from 2018 to mid-2022, so it spans before and after COVID hit. Basically, they tracked how often blood pressure was being recorded, medication use, and whether any of those prescribing patterns shifted after the pandemic began.

Andie Cartwright

And let’s just highlight, for all the data nerds with us—those numbers aren’t just stats. This is day-to-day life for the 80% of nursing home patients with hypertension. Over 90% if we’re talking folks with Alzheimer’s or similar dementias. And even before COVID, managing blood pressure in this setting was tough. So many people with multiple conditions, which means risk of both strokes and heart attacks on one side, and medication side effects—like hypotension—on the other.

Anthony Pero

Exactly. And what jumps out is how care shifted with the pandemic. Monitoring went up—average blood pressure readings per day rose from 1.6 pre-COVID to 1.9 after, regardless of dementia status. Even though the average values didn’t change too much, it’s like everyone was just…tracked more closely. And for good reason—during COVID, a small sign, like a sudden drop in blood pressure, could mean so many things and possibly need to take urgent action.

Andie Cartwright

Yeah, and I was struck by how, when you dig into the severe dementia group, the prevalence of hypotension—so, that really low blood pressure—was almost double compared to those without dementia: 16.3% versus 8.9% if they were on two or more blood pressure meds. That’s not a small gap.

Anthony Pero

No, it’s not, and actually, it reminded me of something from my payer side days. When COVID hit, long-term care facilities were, well…there’s not really a playbook for a crisis on that scale, so everybody was building the plane as it was flying, so to speak. Suddenly, even routine things like blood pressure checks became heightened, sometimes at the expense of addressing the whole person—not just one number on a chart. That tension between “vital sign vigilance” and quality of life became so obvious.

Andie Cartwright

It’s interesting—from a data strategy perspective, you want granular data to spot issues early, but there’s a real danger in just cranking up the volume on monitoring without context. And I think this study really surfaces how protocols meant to be protective sometimes end up putting more burden on staff and residents, especially those with dementia who may not be able to communicate how they’re really feeling. The system gets stretched—and so do the people.

Anthony Pero

And that could lead right into deprescribing. The data showed residents with dementia were less likely to have their hypertension meds dialed back—even when the numbers suggested it might be safer. The hazard ratio was 0.83 after adjusting for age, race, comorbidities—so these are not just chance findings. It’s a real gap. And, Andie, several professional groups, like the American Geriatrics Society, basically say, “Hey, if someone has advanced dementia, rethink piling on more meds. Sometimes, less is more.”

Andie Cartwright

Yeah, that Choosing Wisely recommendation. I mean, it makes total sense on paper—because deprescribing can actually improve life for those with advanced dementia. But the real world is tricky, right? You’ve got these barriers—providers who are cautious, families worried about “giving up,” and, frankly, some clunky systems. I remember working with a startup before PointClickCare, and we built this data-driven review tool for meds—trying to help clinicians flag high-risk situations. And honestly, it was a lot like what MedSafer does now, integrating with PointClickCare to nudge medication reviews. The tools are smart; they sift through a mountain of patient data and spit out pretty specific recommendations. But even with all that, adoption…eh. Let’s just say, habits are hard to break.

Anthony Pero

Totally agree. It's almost a balancing act...a lot comes down to habit, but also fear. Clinicians must consider "If I stop this medication, what if the patient has a stroke? Or what if their family asks why grandma's blood pressure is higher?” But the study found real inertia—deprescribing among residents with dementia lags behind those without dementia, even after all the adjustments. That means it isn’t just case-mix, it’s a systemic behavioral thing.

Andie Cartwright

And honestly, until there are more consistent protocols or even incentives, I just don’t see that changing overnight. What’s interesting from the data is that even though the residents were being monitored more closely after COVID, the safety nets—that is, tools or policies for safely deprescribing—weren’t really keeping pace. Building on what we’ve talked about in past episodes, it’s like data can illuminate the problem, but getting the humans to act on it… That’s the heavy lift.

Andie Cartwright

So here’s where it gets really complicated: more medication isn’t always better, especially if you’re dealing with dementia and a bunch of other health issues. The study highlighted that when residents with dementia were on more antihypertensive meds, both their risk for low blood pressure and poorly controlled high blood pressure went up. And it’s not just numbers—it translates into risk of falls, hospitalizations, or even worse—death. It really underscores that balancing act between blood pressure targets and drug burden is so much trickier in this group.

Anthony Pero

And that’s why these calls for more tailored deprescribing protocols are getting louder. Stuff like pharmacist-led medication reviews for new nursing home residents with really low systolic blood pressure or worrisome symptoms, within the first two weeks—they’re thinking that could make a big difference. If we had systematic reviews like that in place everywhere, I think we’d see fewer falls, a reduction in ER visits and admissions, more folks able to just, I don’t know, enjoy their days instead of being dizzy and tired all the time. Sometimes you can’t rely on residents themselves to flag symptoms—especially with dementia—so regular, proactive review matters.

Andie Cartwright

Yeah, and I think about the success stories we’ve covered before—you know, like the flu vaccination campaigns we talked about last episode? Those worked because there was cross-disciplinary teamwork and accountability. If we bring that same energy to blood pressure management—using data not just to check the box, but to ask, “Is this helping the person sitting right in front of me?”—I’m hopeful we can move the needle. Not just for the numbers, but for their actual quality of life.

Anthony Pero

Absolutely. We need metrics that move from just process to outcome—are we helping people avoid harm, or just making the chart look good? It takes a shift in mindset, not just more data. I know I sound like a broken record, Andie, but if we listen to what the data’s actually telling us, and keep the focus grounded in each resident’s reality, there’s a real chance to improve care in big ways.

Andie Cartwright

I’m totally with you, Anthony. So that’s a wrap for this episode of Better Living Through Data. Thanks for joining us as we dig deeper into the gritty, important questions about medication, quality of life, and change in long-term care. We’ll have more stories and insights in our next episode, so stick with us. Anthony, thanks for a great conversation.

Anthony Pero

Thanks, Andie—always a pleasure. Until next time, everyone, take care and keep asking the tough questions of your data… and your care teams. Bye for now!

Andie Cartwright

Bye, everyone. Talk soon!