Anti-hypertensive drugs deprescribing: an updated systematic review of clinical trials

Abstract

Background Polypharmacy is defined as the prescription of at least 5 different medicines for therapeutic or prophylactic effect and is a serious issue among elderly patients, who are frequently affected by multi-morbidity. Deprescribing is one of the proposed approaches to reduce the number of administered drugs, by eliminating those that are inappropriately prescribed. The aim of this systematic review is to provide an updated and systematic assessment of the benefit-risk profile of deprescribing of anti-hypertensive drugs, which are among the most commonly used drugs. Methods MEDLINE, EMBASE and The Cochrane Library were searched for studies assessing the efficacy and safety of anti-hypertensive drugs deprescribing in the period between January, 12,016 and December, 312,019. The quality of randomized clinical trials (RCTs) was assessed using the GRADE approach for the evaluation of the main outcomes. The risk of bias assessment was carried out using the Cochrane risk-of-bias tool. Results Overall, two RCTs were identified. Despite summarized evidence was in favor of anti-hypertensive deprescribing, the overall risk of bias was rated as high for each RCT included. According to the GRADE approach, the overall quality of the RCTs included was moderate regarding the following outcomes: systolic blood pressure < 150 mmHg after 12 weeks of follow-up, quality of life, frailty and cardiovascular risk. Conclusions This updated systematic review of the efficacy and safety of anti-hypertensive treatment deprescribing found two recently published RCTs, in addition to the previous guideline of the National Institute for Health and Care Excellence (NICE). Evidence points towards non-inferiority of anti-hypertensive deprescribing as compared to treatment continuation, despite the quality of published studies is not high. High quality experimental studies are urgently needed to further assess the effect of deprescribing for this drug class in specific categories of patients.

Medication Use and Costs Among Older Adults Aged 90 Years and Older in Italy

“…The evidence of benefit versus harm over longer periods of treatment in frail multimorbid individuals is scarce, and therefore, a continuous utilization among centenarians appears inappropriate (National Guideline Centre, 2016;Onder et al, 2018). The persistent use of preventive medications might reflect a lack of awareness of physicians toward medication reconciliation, review, and deprescribing (Crisafulli et al, 2021) in the oldest old. This highlights the need for further guidance to improve appropriate prescribing and identify potentially inappropriate medications and potential omissions, thus avoiding any possible age-related bias (Onder et al, 2018;Zazzara et al, 2021).…”

Deprescripción en personas mayores: es el momento de pasar a la acción

“… Expectativa de vida menor que el tiempo preciso para que el fármaco demuestre beneficios relevantes. Sobretratamiento farmacológico (especialmente frecuente en patologías como la hipertensión y la diabetes mellitus) 8 , 9 . …”

“…Sobretratamiento farmacológico (especialmente frecuente en patologías como la hipertensión y la diabetes mellitus) 8 , 9 .…”

“…Existe incertidumbre sobre los posibles efectos beneficiosos y perjudiciales de la retirada de antihipertensivos, aunque parece factible en pacientes que toman estos fármacos en prevención primaria. Una revisión sistemática 9 identificó dos ensayos clínicos en los que la deprescripción no era inferior a la continuación del tratamiento con relación a las cifras de presión arterial. Otra revisión sistemática 17 concluyó que existe escasez de evidencia sobre las situaciones en que se debería aplicar la deprescripción, y ausencia de datos clave importantes, como el efecto de la misma en reducción de caídas o mejoría de la calidad de vida.…”

Actividades preventivas en el mayor. Actualización PAPPS 2022

“…La mayor parte de revisiones sistemáticas no mostraron modificaciones en la calidad de vida, aunque una mostró mejoría medida mediante el Euro-Quol-5D 32 . A nivel específico, una revisión sistemática 33 identificó 2 ensayos clínicos en los que la deprescripción de antihipertensivos no era inferior a la continuación del tratamiento en las cifras de presión arterial. Otra revisión sistemática mostró que la disminución del tratamiento hipoglucemiante no modificó los niveles de hemoglobina glicosilada significativamente, sin aumentar además caídas, hipoglucemias y hospitalizaciones 34 .…”