Blood Pressure Changes Following Antihypertensive Medication Reduction, by Drug Class and Dose Chosen for Withdrawal: Exploratory Analysis of Data From the OPTiMISE Trial

FIGURE 1. Medication reduction algorithm given to general practitioners participating in the Optimize trial NICE = National Institute for Health and Care Excellence. Contraindicated medications described in the STOPP START criteria (Gallagher et al., 2008). Figure adapted from previous publications about this trial (Sheppard et al., 2018; Sheppard et al., 2020c).

FIGURE 2. Relative risk of blood pressure control and adverse events in patients reducing antihypertensive medication compared to usual care, by drug class chosen for withdrawal*. *Since the treating physician’s choice of medication to withdraw was made prior to consent and randomization, data were available for all randomized participants, even though only half went on to have the medication withdrawn in the trial. RR = relative risk; CI = confidence interval. Generalized linear mixed model with binomial error and log link, with factors predictive of physician choice of drug to withdraw (see Table 2) and baseline systolic blood pressure, gender, cognitive function (MoCA Score), EQ-5D-5L Index and Searle Frailty Index as fixed effects.

FIGURE 3. Mean change in blood pressure in patients reducing antihypertensive medication compared to usual care, by drug class chosen for withdrawal* *Since the treating physician’s choice of medication to withdraw was made prior to consent and randomization, data were available for all randomized participants, even though only half went on to have the medication withdrawn in the trial. BP = blood pressure; CI = confidence interval Generalized linear mixed model with binomial error and log link, with factors predictive of physician choice of drug to withdraw (see Table 2) and baseline systolic blood pressure, gender, cognitive function (MoCA Score), EQ-5D-5L Index and Searle Frailty Index as fixed effects and primary care site as a random effect.

FIGURE 4. Relative risk of blood pressure control, adverse events and mean change in blood pressure in patients reducing antihypertensive medication compared to usual care, by dose of medication chosen for withdrawal* *Since the treating physician’s choice of medication to withdraw was made prior to consent and randomization, data were available for all randomized participants, even though only half went on to have the medication withdrawn in the trial. BP = blood pressure; CI = confidence interval Generalized linear mixed model with binomial error and log link, with factors predictive of physician choice of drug to withdraw (see table two) and baseline systolic blood pressure, gender, cognitive function (MoCA Score), EQ-5D-5L Index and Searle Frailty Index as fixed effects and primary care site as a random effect.