Published in Lancet Healthy Longevity, the study followed adults aged 80 and older who were taking two or more medications to lower their blood pressure – known as antihypertensive medication - but did not have elevated blood pressure readings. The study followed the participants for an average of four years and found no evidence of increased risk of hospitalisation, death, heart attacks or strokes when one antihypertensive medication was stopped.
High blood pressure is one of the most common health conditions in older people in the UK and many take two or more medications to treat it. For some older people living with multiple long-term health conditions or frailty, taking several antihypertensive medications could put them at increased risk of adverse events such as fainting, falling, or problems with their kidneys. To reduce these risks, some clinical guidance for the management of high blood pressure recommends reducing the number of antihypertensive medications a patient takes. However, this has not been tested in robust clinical trials until now.
‘The findings of this study suggest that deprescribing antihypertensive medication may be safe in some older patients living in the community, who have been prescribed two or more antihypertensives for a number of years, but have blood pressure in a normal range,’ said, Dr James Sheppard, Associate Professor at NDPCHS and lead author of the study.
Funded by British Heart Foundation and the NIHR, the research followed up on the OPTiIMISE trial which compared outcomes over 12 weeks for patients who stopped taking one antihypertensive medication to those who continued all their medications. The study found that deprescribing one antihypertensive medication was safe in the short term and limited impact on patients’ blood pressure control or quality of life.
The new research revisited the healthcare records of participants four years later and found that there was no evidence of a difference in blood pressure levels or any increased risk of harm for those who had stopped an antihypertensive drug entirely.
‘Although this was the largest study of its kind conducted to date, it was still not large enough to determine whether deprescribing is beneficial for patients and the NHS,’ continued Dr Sheppard. ‘It is likely that deprescribing may only be appropriate in certain older patients and so it should only be undertaken by a GP or qualified medical professional.’
To further assess the safety of deprescribing antihypertensive medication, the researchers are now working on the OPTIMISE2 trial. This trial will build on the findings of OPTiMISE, recruiting more participants and working with patients aged 75 and over who are taking blood pressure lowering drugs, but do not have raised blood pressure readings. General practitioners based in England who are interested in taking part in this new trial should visit the OPTIMISE 2 website or email pcctuoxf.optimise2@nhs.net for more information.
Concluding the findings of the OPTiMISE trial and long-term results, the researchers emphasize that medication changes should always be made carefully, under supervision from a patients’ GP. Deprescribing may not be suitable for all patients, but the findings of the study show encouraging results for tackling polypharmacy and simplifying the care of older people with multiple long-term conditions living in the community.