Key result
Antihypertensive medication in frail older adults may offer minimal cardiovascular benefit and significant harm, highlighting a need for shared decision-making and deprescribing tools.
Why the study?
Hypertension management in frail older adults remains controversial due to underrepresentation in trials and guidelines, with risks from both overtreatment and undertreatment.
Does deprescribing antihypertensive medication improve outcomes or reduce harm in frail older adults?
Does deprescribing antihypertensive medication improve outcomes or reduce harm in frail older adults?
Deprescribing antihypertensive medications in frail older adults should be considered through shared decision-making, as current evidence suggests minimal cardiovascular benefit and significant potential for harm.
Supports deprescribing antihypertensives in frail older adults; extends evidence for individualized BP targets in guidelines.
Purpose of review: The management of hypertension in frail older adults remains controversial, as these patients are underrepresented in clinical trials and practice guidelines. Overtreatment may cause harm while undertreatment may lead to greater risk of cardiovascular events. Our research aims to examine this controversy and provide guidance regarding deprescribing decisions in frail older adults. Results: Current evidence suggests that there may be minimal cardiovascular benefit and significant harm of antihypertensive medication in the frail older adult population. A minority of hypertension guidelines provide sufficient recommendations for frail older adults, and there are limited tools available to guide clinical decision-making. Conclusion: Randomized controlled trials and well-designed observational studies are needed to confirm the benefit-to-harm relationship of antihypertensive medication in frail older adults. Decision tools that comprehensively address antihypertensive deprescribing would be advantageous to help clinicians with hypertension management in this population. Clinicians should engage in shared decision-making with the patient and family to ensure that decisions regarding antihypertensive deprescribing best meet the needs of all involved.
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Kraut et al. (2022) conducted a review in Hypertension in frail older adults. Antihypertensive medication was evaluated. Antihypertensive medication in frail older adults may offer minimal cardiovascular benefit and significant harm, highlighting a need for shared decision-making and deprescribing tools.
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