Clinical question
Is withdrawal of antihypertensive medications feasible, and if so, what are the effects on mortality, cardiovascular outcomes, hypertension and quality of life in older people?
Bottom line
Based on currently available evidence, discontinuation of antihypertensives has no effect on all‐cause mortality, myocardial infarction or stroke when compared with continuation. Shared decision‐making, specification of patient‐specific goals (eg, reversal of side effects or reduction of pill burden) and close monitoring of the effects in the individual remain pillars of clinical practice when deprescribing antihypertensives.
Caveat
The certainty of the evidence was judged to be low or very low for all the outcomes considered in this review. Therefore, there is uncertainty in the evidence for the effect of antihypertensive withdrawal on outcomes overall. The reasons for downgrading the certainty were risk of bias, inconsistency, indirectness and imprecision. Eligible studies were generally small and had short‐term follow‐up with few numbers of events.
Context
Hypertension is an important risk factor for subsequent cardiovascular events, including ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Overall, the use of antihypertensive medications has led to reduction in cardiovascular disease, morbidity and mortality. However, the use of antihypertensive medications is also associated with harms, especially in older people, including the development of adverse drug reactions, drug–drug interactions and increased medication‐related burden. As such, discontinuation of antihypertensives may be considered and appropriate in some older people.
Cochrane Systematic Review
Reeve E, et al. Withdrawal of antihypertensive drugs in older people. Cochrane Database Syst Rev 2020, Issue 6. Art. No.: CD012572. DOI: 10.1002/14651858.CD012572.pub2. This review contains 6 trials with a total of 1073 participants.
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