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The OPTIMISE Randomized Clinical Trial: Deprescribing Antihypertensive Medications in Adults Aged 80 and Older and its Effect on Blood Pressure

Sheppard J, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients with Hypertension Aged 80 Years and Older. JAMA. 2020; doi: 10.1001/jama.2020.4871

Researchers from the University of Oxford conducted a randomized, noninferiority, unblinded study to determine whether deprescribing antihypertensive medications in older patients had an effect on systolic blood pressure (SBP) and adverse events when compared with usual care. In this trial “The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE),” older patients with polypharmacy and multimorbidity across 69 primary care sites in England were randomized to a medication reduction group or usual care. Five hundred and sixty-nine patients were randomized and 534 completed the study and were followed for 12 weeks. At the end of 12 weeks the intervention group demonstrated a mean increase of systolic blood pressure of 3.4 mm Hg (95% CI, 1.1-5.8 mm Hg) when compared to the usual care group, and similar numbers in each group remained at SBP below 150 mm Hg (86% vs 88%). Patients in the intervention group experienced at least 1 serious adverse event at a rate of 4.3%, while the usual care group experienced serious adverse events at rate of 2.4% (adjusted RR, 1.72 [95% CI, 0.7 to 4.3]). While serious adverse event rates were higher in the intervention group, the result was not statistically significant, and the adverse events included several items like inguinal hernia repair that are likely unrelated to blood pressure management. Longer-term outcomes of anti-hypertensive reduction are needed and require further study.

Primary author James Sheppard PhD said of the study population:

“Our trial is the first important step towards understanding whether antihypertensive deprescribing should be encouraged in routine clinical practice. We show that deprescribing is safe in the short term, but larger studies are needed to establish the long-term benefits and harms.”

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