Antihypertensive Deprescribing in Older Adults: a Practical Guide

Sheppard, James P; Bénétos, Athanase; McManus, Richard J

doi:10.1007/s11906-022-01215-3

Cited by 14 publications

(17 citation statements)

References 48 publications

(74 reference statements)

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“…However, recent studies like HYVET [2] and SPRINT [3] have shown benefits of antihypertensive therapy in older patients (> 75 years) as well. Nevertheless, older patients are known to be more susceptible to Adverse Drug Events (ADEs) of antihypertensives, which increase the risk of hospital admissions [1,[4][5][6][7]. Therefore, guidelines helping to assess the benefit-risk balance for an individual patient are highly recommended [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…These ADEs were mainly associated with the use of multiple antihypertensive medications [4][5][6]. In older patients, because of frailty and pharmacokinetic changes, these side effects may occur more frequently or may be more serious [7][8][9]. Also, the benefits of antihypertensives in older patients depend on the estimated life expectancy [1,4,7,10].…”

Section: Introductionmentioning

confidence: 99%

“…In older patients, because of frailty and pharmacokinetic changes, these side effects may occur more frequently or may be more serious [7][8][9]. Also, the benefits of antihypertensives in older patients depend on the estimated life expectancy [1,4,7,10]. And last but not least, observational studies have shown an increased mortality in frail older patients using multiple antihypertensive drugs [7,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Also, the benefits of antihypertensives in older patients depend on the estimated life expectancy [1,4,7,10]. And last but not least, observational studies have shown an increased mortality in frail older patients using multiple antihypertensive drugs [7,10,11]. Therefore, when the negative effects outweigh the benefits in older patients, deprescribing antihypertensives may be appropriate.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, when the negative effects outweigh the benefits in older patients, deprescribing antihypertensives may be appropriate. This is especially the case in older patients who use two or more antihypertensive medication and may suffer from ADEs caused by these medication, as these patients are at a higher risk for hospital admissions and negative impact on their health [1,[4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of a protocol for deprescribing antihypertensive medication in older patients in Dutch general practices

et al. 2022

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Background Older patients using antihypertensive medication may experience Adverse Drug Events (ADEs), and thus benefit from deprescribing. The lack of a practical protocol may hamper deprescribing. Therefore, we aimed to develop a deprescribing protocol, based on a review of literature, combined with a feasibility test in a small number of patients. Methods A deprescribing protocol for general practitioners was drafted and tested in older patients using multiple antihypertensive medication in a single arm intervention. Patients were included if they were 75 years or older, were using two or more antihypertensives, had at least one ADE linked to antihypertensive medication and deprescribing was considered to be safe by their general practitioner. The primary outcome was the percentage of patients for whom one or more antihypertensive drugs were stopped or reduced in dose after 12 months of follow up while maintaining safe blood pressures. Secondary outcomes were the proportion of patients reporting no ADEs after 12 months and the number of deprescribed antihypertensives. Patient’s opinions on deprescribing and enablers and barriers for study participation were also collected. Results Nine general practitioners included 14 patients to deprescribe antihypertensive medication using the deprescribing protocol. After 12 months antihypertensive drug use was lowered in 11 patients (79%). These patients had a mean systolic blood pressure increase of 16 mmHg and a mean diastolic blood pressure increase of 8 mmHg. Nine patients (64%) reported experiencing no ADEs anymore after twelve months. The mean number of deprescribed antihypertensives was 1.1 in all patients and 1.4 (range: 0.5 to 3.5) in patients who successfully lowered their medication. At baseline, being able to use less medication was the most frequently mentioned enabler to participate in this study. The most frequently mentioned positive experience at the end of the study was using less medication, which was in line with the most mentioned enabler to participate in this study. Conclusion A protocol for deprescribing antihypertensives in older patients was considered feasible, as it resulted in a substantial degree of safe deprescribing in this pilot study. Larger studies are needed to demonstrate the effect and safety of deprescribing antihypertensives in older patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility of a protocol for deprescribing antihypertensive medication in older patients in Dutch general practices

et al. 2022

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Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents

Jing,

Liu,

Graham

et al. 2024

JAMA Intern Med

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ImportanceAntihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain.ObjectiveTo investigate the association of deprescribing antihypertensive medication with changes in cognitive function in nursing home residents.Design, Setting, and ParticipantsThis cohort study using a target trial emulation approach included VA long-term care residents aged 65 years or older with stays of at least 12 weeks from 2006 to 2019. Residents who were not prescribed antihypertensive medication, with blood pressure greater than 160/90 mm Hg, or with heart failure were excluded. Eligible residents with stable medication use for 4 weeks were classified into deprescribing or stable user groups and followed for 2 years or until death or discharge for intention-to-treat (ITT) analysis. Participants switching treatment groups were censored in the per-protocol analysis. Cognitive function measurements during follow-up were analyzed using an ordinal generalized linear mixed model, adjusting for confounders with inverse probability of treatment weighting. Per-protocol analysis included inverse probability of censoring weighting. Data analyses were performed from May 1, 2023, and July 1, 2024.ExposuresDeprescribing was defined as a reduction in the total number of antihypertensive medications or a decrease in medication dosage by 30%, sustained for a minimum of 2 weeks.Main Outcomes and MeasuresCognitive Function Scale (CFS) was classified as cognitively intact (CFS = 1), mildly impaired (CFS = 2), moderately impaired (CFS = 3), and severely impaired (CFS = 4).ResultsOf 45 183 long-term care residents, 12 644 residents (mean [SD] age 77.7 [8.3] years; 329 [2.6%] females and 12 315 [97.4%] males) and 12 053 residents (mean [SD] age 77.7 [8.3] years; 314 [2.6%] females and 11 739 [97.4%] males) met eligibility for ITT and per-protocol analyses, respectively. At the end of the follow-up, 12.0% of residents had a worsened CFS (higher score) and 7.7% had an improved CFS (lower score) with 10.8% of the deprescribing group and 12.1% of the stable user group showing a worsened CFS score. In the per-protocol analysis, the deprescribing group had a 12% reduction in the odds of progressing to a worse CFS category per 12-week period (odds ratio, 0.88; 95% CI, 0.78-0.99) compared to the stable user group. Among residents with dementia, deprescribing was associated with 16% reduced odds of cognitive decline (odds ratio, 0.84; 95% CI, 0.72-0.98). These patterns remained consistent in the ITT analysis.Conclusions and RelevanceThis cohort study indicates that deprescribing is associated with less cognitive decline in nursing home residents, particularly those with dementia. More data are needed to understand the benefits and harms of antihypertensive deprescribing to inform patient-centered medication management in nursing homes.

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Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review

Sheppard,

Benetos,

Bogaerts

et al. 2024

Curr Hypertens Rep

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Purpose of Review To summarise the evidence regarding which patients might benefit from deprescribing antihypertensive medications. Recent Findings Older patients with frailty, multi-morbidity and subsequent polypharmacy are at higher risk of adverse events from antihypertensive treatment, and therefore may benefit from antihypertensive deprescribing. It is possible to examine an individual’s risk of these adverse events, and use this to identify those people where the benefits of treatment may be outweighed by the harms. While such patients might be considered for deprescribing, the long-term effects of this treatment strategy remain unclear. Summary Evidence now exists to support identification of those who are at risk of adverse events from antihypertensive treatment. These patients could be targeted for deprescribing interventions, although the long-term benefits and harms of this approach are unclear. Perspectives Randomised controlled trials are still needed to examine the long-term effects of deprescribing in high-risk patients with frailty and multi-morbidity.

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Antihypertensive Deprescribing in Older Adults: a Practical Guide

Cited by 14 publications

References 48 publications

Feasibility of a protocol for deprescribing antihypertensive medication in older patients in Dutch general practices

Feasibility of a protocol for deprescribing antihypertensive medication in older patients in Dutch general practices

Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents

Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review

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