Is blood pressure control possible with medication reduction in older patients?

  • Sheppard JP & al.
  • JAMA
  • 26 May 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Medication reduction in older patients treated with multiple antihypertensive medications was noninferior to usual care with regard to the proportion of patients with systolic blood pressure (SBP) lower than 150 mmHg at 12 weeks.

Why this matters

  • Findings suggest that antihypertensive medication reduction can be achieved in some older patients with hypertension without substantial change in blood pressure (BP) control.

Study design

  • This noninferiority OPTIMISE trial included 569 participants (mean age, 84.8 years; median of 2 antihypertensive medications prescribed at baseline) randomly assigned to a strategy of antihypertensive medication reduction (intervention group; n=282) or usual care (control group; n=287).
  • Primary outcome: SBP
  • Funding: National Institute for Health Research.

Key results

  • Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had a SBP
  • At 12 weeks, medication reduction was maintained in 187 (66.3%) participants in the intervention group.
  • Mean change in SBP (adjusted mean difference, 3.4 [95% CI, 1.0-5.8] mmHg; P=.005) and diastolic BP (adjusted mean difference, 2.2 [95% CI, 0.9-3.6] mmHg; P=.001) was higher in the intervention group vs. the control group.
  • Overall, 12 (4.3%) participants in the intervention group and 7 (2.4%) in the control group reported ≥1 serious adverse event (adjusted risk ratio, 1.72; 95% CI, 0.68-4.29).
  • No statistically significant differences were observed between groups in frailty, quality of life, adverse effects, or serious adverse events at follow-up.

Limitations

  • Participants were selected based on the primary care physician’s view.
  • Unblinded design.