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

Abstract

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.

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

“…Even more recently, a small study [ 53 ] assessed the feasibility of deprescribing antihypertensive treatment in adults aged 75 years or older with two or more antihypertensive drugs that had a physical complaint mentioned in their electronic patient record related to these drugs. During a 1-year follow-up period, 11 out of 14 (79%) participants deprescribed a portion of their antihypertensive treatment while their blood pressure was maintained at an acceptable level, and 9 out of 14 (64%) reported no further adverse drug events after 12 months [ 53 ]. Finally, a trial not yet published in full on antihypertensive deprescribing in nursing home residents with dementia was stopped early on advice of the Data Safety Monitoring Board [ 54 ].…”

Gyógyszerrosta: a racionális gyógyszeres terápia meghatározó eleme

“…Összességében elmondható, hogy míg a betegek esetében a leginkább pszichoszociális befolyásoló tényezőket (hiedelmek, meggyőződések, aggodalmak, preferenciák [46]) írnak le a tanulmányok, addig az egészségügyi szakemberek esetében a pszichoszociális faktorokon túl a gyakorlati tényezők (a beteg, a munkakörülmények, az egészségügyi rendszer [42]) is nagymértékben befolyásolják a folyamatot [51]. Mindazonáltal mind a betegek, mind az egészségügyi szakemberek hajlamosak túlbecsülni a gyógyszeres terápia lehetséges előnyeit és alábecsülni a kezelés hátrányait, az esetlegesen fellépő nem kívánt hatásokat [52].…”