Blood Pressure Changes Following Antihypertensive Medication Reduction, by Drug Class and Dose Chosen for Withdrawal: Exploratory Analysis of Data From the OPTiMISE Trial

Aims: Deprescribing of antihypertensive drugs is recommended for some older patients with polypharmacy, but there little evidence to inform which drug (or dose) should be withdrawn. This study used data from the OPTiMISE trial examine whether short-term outcomes deprescribing vary by class and dose medication Methods: The included aged ≥80 years controlled systolic blood pressure (SBP; <150 mmHg), receiving ≥2 medications. compared SBP control, mean change in frequency adverse events after 12 weeks participants stopping one vs. usual care, equivalent Equivalent was determined according defined daily (DDD) each type. Drugs prescribed below DDD were classed as low those at ≥DDD described higher dose. Outcomes examined generalized linear mixed effects models. Results: A total 569 randomized, 85 ± 3 (mean 130/69 mmHg). Within calcium channel blockers, medications more commonly selected withdrawal (90 10%). In beta-blockers, chosen (87 13%). Withdrawal blockers associated an increase (5 mmHg, 95%CI 0–10 mmHg) reduced control (adjusted RR 0.89, 0.80–0.998) care. contrast, beta-blockers no (−4 −10 2 difference 1.15, 0.96–1.37). Similarly, BP control. lower not a or There association between specific classes events. Conclusion: These exploratory suggest avoided if goal maintain However, may removed impact on over 12-weeks follow-up. Larger studies are needed confirm these associations.