To evaluate hypertension (HTN) management and antihypertensive deprescribing among US nursing home (NH) residents with and without dementia, before and after the onset of the COVID-19 pandemic.

Retrospective cohort study.

Newly admitted NH residents with HTN treated with an antihypertensive medication who were not receiving hospice from >1100 NHs using a common electronic health record vendor (January 2, 2018-July 3, 2022) (N = 141,630).

During an 8-week follow-up period beginning on day 14 in the NH after admission (index date), we measured average blood pressure (BP), BP variability, and prevalence of hypo-/hypertension stratified by dementia status and pre– and post–COVID-19 onset (admission before vs on/after March 11, 2020). We measured antihypertensive medication deprescribing (dose/frequency decreases or cessation for ≥7 days) during a 90-day follow-up and estimated hazard ratios by dementia status using Cox hazards regression models adjusted for demographics and comorbidities. Residents were followed until their first deprescribing event or censoring (discharge, death, 90 days, or July 3, 2022).

BP monitoring was similar between those with and without dementia, but increased post–COVID-19 (eg, 1.6 readings per day pre–COVID-19 vs 1.9 readings per day post–COVID-19 in residents with dementia). Residents with severe dementia had a higher prevalence of hypotension compared with residents without dementia (eg, 16.3% vs 8.9% with at least 1 systolic BP <90 mm Hg among those treated with 2 classes). Residents with dementia were less likely to experience deprescribing than those without dementia (fully adjusted hazard ratio, 0.83; 95% CI, 0.79-0.86).

Findings suggest potential overtreatment of HTN among residents with dementia and increased BP monitoring during the COVID-19 pandemic. Results highlight potential opportunities for deprescribing to balance BP control and medication, and monitoring burden in NH.