Frailty, polypharmacy, and the case for pragmatic prescribing in primary care

Primary care clinicians are often caught between conflicting recommendations for clinical care. On one side, specialist guidelines and trial evidence urge intensive treatment, such as tight blood pressure control, aggressive lipid lowering, and comprehensive heart failure regimens, regardless of frailty. Others, such as the British Geriatrics Society’s 2025 guidance on pragmatic prescribing for people living with moderate or severe frailty, advocate shared decision making and less intensive treatment strategies for conditions such as hypertension, diabetes, or heart failure.