Key result
Deprescribing one antihypertensive in older adults is not linked to increased hospitalization or death.
Why the study?
The generalisability of the OPTiMISE trial findings—showing deprescribing one antihypertensive drug did not worsen blood pressure control or cause long-term harm—to routine clinical practice remained uncertain.
Does deprescribing one antihypertensive drug increase the risk of all-cause hospitalisation or death in a real-world population of adults aged ≥80 years on ≥2 antihypertensive drugs?
Observational (n=798,179)
Yes
Does deprescribing one antihypertensive drug increase the risk of all-cause hospitalisation or death in a real-world population of adults aged ≥80 years on ≥2 antihypertensive drugs?
Calibrating the OPTiMISE trial results to a frailer, real-world primary care population confirms that deprescribing one antihypertensive medication in adults aged ≥80 years does not increase the risk of hospitalization or death.
Deprescribing one antihypertensive was not associated with higher hospitalization or death risk in frail adults ≥80; extends OPTiMISE calibration to real-world data but leaves confirmation to RCTs.
BACKGROUND: While antihypertensive treatment prevents cardiovascular events, it may also increase risks such as falls in patients with frailty. The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTiMISE) trial found that deprescribing one antihypertensive drug did not result in worse short-term blood pressure control and long-term follow-up showed no observed harm, but its generalisability to routine clinical practice remains uncertain. OBJECTIVE: This study aimed to calibrate the OPTiMISE effect to a representative primary care population in England. METHODS: We calibrated the OPTiMISE treatment effect using inverse probability weighting (IPW) based on trial inclusion likelihood. The trial enrolled 569 adults aged ≥80 years with controlled blood pressure on ≥2 antihypertensive drugs. A target population was reconstructed from electronic health records of 24 participating practices and extrapolated to all English adults aged ≥80 years, prescribed ≥2 antihypertensive drugs, using NHS Digital data. The primary outcome was all-cause hospitalisation or death. Weighted Cox models estimated calibrated hazard ratios (HRs). RESULTS: The target population included 798 179 individuals (median age 84 years [81-87], 48% female). Compared with OPTiMISE participants, a higher proportion of individuals in target population were overtly frail (25% vs. 11%). After calibration using IPW, deprescribing was not associated with higher risk of hospitalisation or death [calibrated HR 0.94 (95% CI: 0.73-1.22)], similar to the long-term follow-up of OPTiMISE [HR 0.93 (95% CI: 0.76-1.12)], although with a slightly wider confidence interval. CONCLUSIONS: Calibrating OPTiMISE findings to a representative primary care population frailer than the original participants suggests that the original trial findings could be translated into a real-world population.
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Christiaens et al. (2026) conducted an observational in Hypertension (n=798,179). Deprescribing one antihypertensive drug vs. Continuation of antihypertensive drugs was evaluated on All-cause hospitalisation or death (HR 0.94, 95% CI 0.73-1.22). Deprescribing one antihypertensive drug in a real-world population of older adults was not associated with a higher risk of hospitalisation or death (calibrated HR 0.94; 95% CI 0.73-1.22).
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