Abstract Body

Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and multimorbidity when the benefits of continued treatment may not outweigh the harms. The presentation will focus on the current evidence for deprescribing antihypertensive medications in primary care with particular focus on the recent OPTIMISE randomized, controlled, non-inferiority trial conducted in primary care in England. This study enrolled participants aged 80 years and older, with systolic blood pressure lower than 150 mmHg and prescription for 2 or more antihypertensive medications. Participants were randomized (1:1) to a strategy of antihypertensive medication reduction (removal of 1 drug) or usual care, in which no medication changes were mandated. The primary outcome was systolic blood pressure lower than 150 mmHg at 12-week follow-up. Among 569 patients randomized (mean age, 84.8 years), 534 (93.8%) completed the trial. Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had a systolic blood pressure lower than 150 mmHg at 12 weeks (adjusted RR, 0.98 [97.5% 1-sided CI, 0.92 to ∞]). Medication reduction was sustained in 187 (66.3%) participants at 12 weeks. Mean change in systolic blood pressure was 3.4 mm Hg (95% CI, 1.1 to 5.8 mm Hg) higher in the intervention group compared with the control group. These findings suggest antihypertensive medication reduction is not associated with substantial change in blood pressure control in some older patients, although further research is needed to understand long-term clinical outcomes.