Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review

Abstract

Purpose of Review To summarise the evidence regarding which patients might benefit from deprescribing antihypertensive medications. Recent Findings Older patients with frailty, multi-morbidity and subsequent polypharmacy are at higher risk of adverse events from antihypertensive treatment, and therefore may benefit from antihypertensive deprescribing. It is possible to examine an individual’s risk of these adverse events, and use this to identify those people where the benefits of treatment may be outweighed by the harms. While such patients might be considered for deprescribing, the long-term effects of this treatment strategy remain unclear. Summary Evidence now exists to support identification of those who are at risk of adverse events from antihypertensive treatment. These patients could be targeted for deprescribing interventions, although the long-term benefits and harms of this approach are unclear. Perspectives Randomised controlled trials are still needed to examine the long-term effects of deprescribing in high-risk patients with frailty and multi-morbidity.

Deprescribing antihypertensive drugs in frail older adults

“…While the short-term evidence is supportive, there is uncertainty regarding the longer-term benefits and harms. 20 …”

“…The risk of adverse outcomes when deprescribing, such as withdrawal effects, can be minimised or prevented through appropriate patient engagement, planning, tapering, monitoring and clinical handover. 17 , 18 , 20 , 29 , 30 If there are other prescribers involved in the patient’s care (e.g. a cardiologist), they should also be engaged in deprescribing decisions.…”

“…In most cases, antihypertensive doses should be tapered before stopping the drug. 17 , 18 , 20 , 29 , 30 Abrupt cessation of beta blockers can lead to a rebound phenomenon of angina, anxiety, severe hypertension, tachycardia and can cause a myocardial infarction. Clonidine can also cause a withdrawal syndrome if it is not tapered.…”

“…While the other classes of antihypertensive drugs have not been clearly associated with withdrawal effects, abrupt cessation can lead to rapid return of hypertension, or in the case of diuretics, fluid accumulation. 17 , 20 , 29 , 30…”