Among 553,519 skilled nursing facility (SNF) residents with documented hypertension diagnoses drawn from over 1.28 million long-term care records in PointClickCare's database, 87.7% had at least one antihypertensive medication order. Calcium channel blockers (44.3%) and beta-blockers (43.5%) dominated prescribing. Modified Poisson regression revealed that residents concurrently prescribed hyperlipidemia or diabetes medications were more likely to receive antihypertensives (RR 1.09 and 1.05), while those with hypertension diagnoses alone—without accompanying pharmacotherapy for comorbidities—showed meaningfully lower treatment likelihood, as did residents covered by non-Medicare/Medicaid payers (RR 0.91).
The 12.3% treatment gap in this vulnerable, institutionalized population is clinically significant. Older adults in SNFs carry disproportionate cardiovascular risk, and uncontrolled hypertension accelerates stroke, kidney decline, and cognitive deterioration—conditions that erode both lifespan and healthspan. The payer-type disparity hints at structural inequities that prescribing guidelines alone cannot resolve. Notably, the diagnosis-medication paradox—whereby a diabetes or hyperlipidemia diagnosis alone predicts lower antihypertensive prescribing, while active pharmacotherapy for those same conditions predicts higher rates—may reflect documentation lag or care fragmentation worth investigating further. This preprint has not yet undergone peer review, and its retrospective, observational design precludes causal inference. Nonetheless, the dataset's scale makes this among the largest real-world analyses of SNF hypertension management to date. The findings are largely confirmatory of known prescribing gaps but add granularity that could inform targeted quality-improvement interventions in long-term care settings.