Challenging the status quo: deprescribing antihypertensive medication in older adults in primary care

Antihypertensive treatment in older adultsAntihypertensive medications are commonly prescribed in primary care 1 and are effective at preventing cardiovascular disease in patients of all ages. 2 However, treatment is not without harm, with trials showing an increased risk of hypotension, syncope, acute kidney injury, hyperkalaemia, hypokalaemia and hyponatremia with antihypertensive treatment, particularly in older and/ or patients with increasing frailty. 3,4Such patients also have an increased risk of cardiovascular disease, making them more likely to benefit from continued treatment, meaning it is hard for primary care clinicians to know how best to balance these risks.National Institute for Health and Care Excellence (NICE) guidelines are vague in this regard, recommending that 'clinical judgement' is used when prescribing antihypertensive medication to older patients with frailty and multiple long-term conditions. 5ere there are concerns about the harms of antihypertensive treatment, one option is to withdraw or 'deprescribe' medication.Deprescribing is a planned and supervised process of stopping a medication that might cause harm or is no longer beneficial. 6It is an essential aspect of good prescribing, reducing medication burden with the potential to improve quality of life.While deprescribing is common in nursing homes in response to adverse events such as incident low blood pressure or a serious fall, 7 pre-emptive deprescribing is not discussed in NICE guidelines and less common practice in primary care.This is perhaps with good reason, given that until recently, there was very little evidence to inform GPs about what happens when antihypertensive medications are stopped in older adults. 8