- 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
- These results contrast with those of a recent single study finding a survival benefit in treating hypertension in older patients with frailty.
- 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.
- 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.
- Evidence was low certainty at best.
- Sources of bias included reporting, detection, and performance biases.