Hypertension Pharmacotherapy in Skilled Nursing Facilities: A Real-World Evidence Study

Objectives: To evaluate rates of pharmacological hypertension orders and identify resident- and facility-level predictors of pharmacologic care among skilled nursing facility (SNF) residents in the United States. Design: Retrospective, observational study. Setting and Participants: Electronic Health Record data from 1,285,062 long-term care residents in PointClickCare's Life Sciences database in facility on April 30, 2025 were reviewed, and 553,519 SNF residents with a documented hypertension diagnosis were identified. Methods: The presence and absence of medication orders for antihypertensive treatment recommended by the International Society of Hypertension was assessed. Descriptive analyses summarized demographic and clinical characteristics, and a modified Poisson regression model was used to estimate risk ratios (RRs) for having a medication order, adjusting for demographic, clinical, and facility characteristics. Results: Overall, 87.7% of residents diagnosed with hypertension had at least one antihypertensive medication order. Calcium channel blockers (44.3%) and beta blockers (43.5%) were the most frequently used classes. RRs ranged from 0.91 to 1.09. Higher likelihoods of antihypertensive orders were observed among residents prescribed hyperlipidemia and diabetes medication (RR = 1.09 and 1.05, respectively), while lower likelihoods of treatment were observed for other payer types (RR = 0.91), diabetes diagnoses (RR = 0.95), and hyperlipidemia diagnoses (RR = 0.98). Conclusions and Implications: Most residents with hypertension had orders for recommended pharmacologic therapy, although important gaps and disparities remain. The predominance of certain medication classes and persistent differences by comorbidity and facility type underscore the need for targeted strategies to improve equitable prescribing and access to evidence-based hypertension management in SNF settings.