Antihypertensive cessation in older adults: equivocal Cochrane findings

  • Reeve E & al.
  • Cochrane Database Syst Rev
  • 10 Jun 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Stopping antihypertensives in older patients does not yield different outcomes from continuing them, according to the results of this Cochrane review.
  • The authors caution against drawing any firm conclusions because of the low-certainty evidence.

Why this matters

Key results

  • The meta-analysis included 6 randomized controlled trials including 1073 participants, average ages 58-82 years.
  • The authors say that stopping vs continuing the drugs had no effect (ORs; 95% CIs) on:
    • all-cause mortality: 2.08 (0.79-5.46);
    • myocardial infarction: 1.86 (0.19-17.98); or
    • stroke: 1.44 (0.25-8.35).
  • There was also no difference for QoL or hospitalization.
  • They caution that the evidence is low or very low certainty because of small studies with short follow-up.
  • BP did go up with discontinuation, requiring reinitiation of therapy in 10.5%-33.3% of participants.

Study design

  • Included randomized controlled trials published up to April 2019 that compared withdrawal vs not in patients age 50+ years.
  • Funding: Various sources of university support.

Limitations

  • Evidence was low certainty at best.
  • Sources of bias included reporting, detection, and performance biases.