Is it protected to cut back blood stress medicines for older adults? – . Well being Weblog

“Doctor, can you take my medication away from me? I am taking too many pills. "

As doctors, we hear this request a lot. The population most affected by the prescription of multiple drugs known as polypharmacy are the elderly. Trying to organize long lists of medications and remembering to take them exactly as prescribed can become a full-time job. In addition to the physical and emotional burden of organizing medication, older adults are at increased risk of certain types of side effects and potentially poorer outcomes from polypharmacy.

A common source of prescriptions is high blood pressure, with older adults often taking several medications to lower their blood pressure. Data from the Framingham Heart Study shows that over 90% of middle-aged people develop high blood pressure at some point, and at least 60% continue to take medications to lower blood pressure.

The OPTIMIZE study recently published in JAMA looked at the effect of reducing the number of blood pressure medications, also known as deprescribing, in the elderly.

How low should blood pressure be in older adults?

Previous large studies, including the HYVET study and the more recent SPRINT study, have shown that treating high blood pressure in older adults remains important and can reduce the risk of heart attack, heart failure, stroke, and cardiovascular death. Black adults made up 31% of the SPRINT study population; Therefore, study results could be used to make recommendations for this population at increased risk of high blood pressure. However, many groups of the elderly have been excluded, including nursing home residents, those with dementia, diabetics, and other conditions common in more frail older adults.

The latest guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) released in 2017 define the optimal blood pressure as less than 120/80 for most people, including older adults 65 and older. They recommend a target of 130/80 for blood pressure treated with medication. The European Society of Cardiology (ESC) and European Society of High Blood Pressure (ESH) guidelines for 2018 recommend a more relaxed goal of less than 140/90.

The US and European populations differ in their risk of cardiovascular disease, with the US population generally at greater risk of stroke, heart failure, and heart attack. Therefore, it may be appropriate to set different blood pressure goals for these two groups. Regardless, both groups recognize that factors such as frailty, limited life expectancy, dementia, and other medical issues should be considered when developing individual goals for patients.

What happened to elderly patients whose blood pressure medication was lowered?

The OPTIMIZE study provided preliminary evidence that some older adults may be able to decrease the number of blood pressure medications they are taking without causing large increases in blood pressure. For the study, researchers randomized 569 patients aged 80 years or older with systolic blood pressure less than 150 mm Hg to either keep their current blood pressure medication or to remove at least one blood pressure medication according to a set protocol. The subjects were observed for 12 weeks to assess the blood pressure response.

The researchers found that both those who took their previous blood pressure medication and those who reduced the number of medications had similar blood pressure controls by the end of the study. While the mean increase in systolic blood pressure for the group taking the drugs was 3.4 mm Hg higher than that for the control group, the number of patients whose systolic blood pressure was below the target of 150 mm Hg at the end of the study was not significantly different between groups. About two thirds of the patients were able to stay off the medication at the end of the study.

It is important to note that OPTIMIZE is a relatively small study and the researchers did not look at long-term outcomes such as myocardial infarction, heart failure, or stroke for this study (as they did with the HYVET and SPRINT studies). I don't know how a prescription would work in the long term.

More research is needed to examine the long-term effects of prescribing

While the OPTIMIZE study showed promise, larger and longer-running studies are needed that examine results beyond blood pressure to really know if a prescription is safe in the long run. Additionally, these researchers used a target systolic blood pressure less than 150 mm Hg, which is higher than the latest ACC / AHA and ESC / ESH recommendations.

An interesting aspect of this study design is that the GP had to feel that the patient is a good candidate for the prescription. This left room for clinicians, who might know patients well, to individualize their prescribing decisions.

The final result

This study provides assistance to physicians and other prescribers in evaluating a study of prescribing blood pressure medication for selected elderly patients with the aim of improving quality of life. These patients must be closely watched to monitor their reactions.

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