Safety and Efficacy of Antihypertensive Deprescribing in Frail Geriatric Patients: A Narrative Review of Contemporary Clinical Trial Evidence

Polypharmacy with antihypertensive agents in frail older adults presents a clinical dilemma: continuing therapy may preserve cardiovascular protection, yet it simultaneously increases the risk of orthostatic hypotension, falls, and drug-related adverse events. This narrative review synthesizes contemporary clinical evidence on the safety and efficacy of antihypertensive deprescribing (gradual withdrawal or dose reduction) in frail geriatric populations, particularly those residing in long-term care facilities. Literature searches were conducted in PubMed/MEDLINE, Cochrane Library, and Google Scholar (2011–2025). Key findings include: the OPTIMISE randomized trial, which demonstrated that withdrawing one antihypertensive agent in patients aged ≥80 years was non-inferior to usual care for systolic blood pressure control over 12 weeks, with 66% sustaining the reduction. The DANTE trial found no cognitive benefit from discontinuation in older adults with mild cognitive impairment. Observational data from the PARTAGE study revealed that low systolic blood pressure combined with ≥2 antihypertensives was associated with increased two-year mortality in frail nursing home residents, supporting the rationale for deprescribing in this subgroup. A Cochrane systematic review (2020, updated 2023) encompassing six trials (1,073 participants) found no significant association between antihypertensive withdrawal and mortality, myocardial infarction, stroke, or hospitalization, though evidence on falls and quality of life remains limited. Overall, current evidence supports selective, closely monitored deprescribing in frail geriatric patients. However, long-term outcomes and data specific to Asian populations, including Indonesia, remain scarce, underscoring the need for further research.