Many older adults take several medicines every day, including drugs to control high blood pressure.
As people age and their health needs change, doctors sometimes consider whether every medicine is still necessary or whether some treatments could be reduced or stopped.
This process is known as deprescribing. The goal is not simply to remove medicines, but to reduce treatments that may no longer provide enough benefit or that could add side effects, interactions or an unnecessary daily burden.
A study led by Dr. Michelle C. Odden of Stanford University examined what happened when blood pressure medicines were deprescribed in people living in long-term care facilities. The findings were published in JAMA Network Open.
High blood pressure is a major risk factor for heart attack and stroke, so medicines that lower it can be very important. However, treatment decisions can become more complicated in frail older adults, who may have several illnesses and may be more vulnerable to dizziness, falls or very low blood pressure.
The researchers analyzed information from 13,096 U.S. veterans who lived in long-term care facilities between 2006 and 2019. Everyone included in the study was taking at least one medicine for high blood pressure.
The team compared residents who continued taking their blood pressure medicines with those whose treatment was reduced or stopped during a 12-week period. About 17.8% of the veterans had at least one of these medicines deprescribed.
Researchers then followed the residents for up to two years and looked for hospital admissions caused by heart attacks or strokes. These are two of the main health problems that blood pressure treatment is intended to help prevent.
At first glance, 11.2% of people in the deprescribing group were hospitalized for heart attack or stroke, compared with 8.8% of those who continued their medicines. However, people whose medicines are stopped may differ in important ways from those who remain on treatment.
The researchers therefore adjusted their analysis to account for a range of differences between the groups. After those adjustments, they found no significant evidence that deprescribing blood pressure medicines increased the risk of hospitalization for heart attack or stroke.
The results suggest that reducing blood pressure treatment may be reasonable for some people in long-term care. They do not mean that older adults should simply stop taking blood pressure medicine or that the drugs are unnecessary.
Treatment needs can vary greatly from person to person. Someone with a history of stroke, heart disease or very high blood pressure may face different risks from someone who is frail, has low blood pressure or is experiencing medication side effects.
The study also cannot prove that deprescribing is completely safe. It was an observational study, meaning researchers examined what happened in real-world medical care rather than randomly assigning people to continue or stop treatment.
Although the researchers tried to account for many differences between patients, there may have been other factors they could not measure. Those hidden differences could have influenced both the decision to deprescribe and the patients’ later health outcomes.
The researchers said randomized clinical trials would provide stronger evidence. Such studies can be difficult to conduct among long-term care residents because many participants have complex health conditions and treatment plans that need to be highly individualized.
Even so, the findings add useful evidence to a growing discussion about medication burden in older adults. Taking many medicines can make treatment harder to manage and can increase the chance of side effects or interactions between drugs.
For long-term care residents, decisions about blood pressure treatment should therefore involve careful discussion among clinicians, patients and families. The study suggests that, for selected older adults, reducing treatment may be possible without automatically increasing the risk of serious heart or brain problems.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and natural coconut sugar could help reduce blood pressure and artery stiffness.
For more health information, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing vitamin D could improve blood pressure in people with diabetes.
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