Hypertension affects nearly all Veterans, and the Veterans Health Administration is leading the nation in improving blood pressure control. However, we have found that older Veterans with diabetes are more likely to be over-treated with blood pressure medications than younger Veterans. This research stems from concern over older patients' intolerance to low blood pressure and multiple medications, potentially leading to injurious falls. We will develop a new measure of Aggressive Hypertension Control (AHC) in older Veterans, and study whether AHC leads to harm from fall injury that outweighs benefit from cardiovascular events. We will consider if the risk-benefit balance differs depending on individual Veterans' prior risk of cardiovascular disease or falling. Last, we will investigate system-level mechanisms leading to AHC, leading to new ways to improve health outcomes in a Veteran-centered way.
