General practitioners are reluctant to start or deprescribe antihypertensive medication in older people, influenced by patient preferences, anticipated regret, and insufficient guideline support.
What are the routines and considerations of general practitioners regarding prescribing and deprescribing antihypertensive medication in older patients?
General practitioners experience barriers to deprescribing antihypertensive medications in older adults, highlighting a need for better guideline support for medication review and deprescription.
OBJECTIVES: To explore general practitioners' (GPs) routines and considerations on (de)prescribing antihypertensive medication (AHM) in older patients, their judgement on usability of the current guideline and needs for future support. DESIGN: Semistructured interviews. SETTING: Dutch general practice. PARTICIPANTS: Fifteen GPs were purposively sampled based on level of experience and practice characteristics until saturation was reached. RESULTS: GPs appeared reluctant to start AHM, especially in patient >80 years. High systolic blood pressure and history of cardiovascular disease or diabetes were enablers to start or intensify treatment. Reasons to refrain from this were frailty and patient preference. GPs described a tendency to continue AHM regimens unchanged, influenced by daily time constraints, automated prescription routines and anticipating discomfort when disturbing patients' delicate balance. GPs were only inclined to deprescribe AHM in terminally ill patients or after prolonged achievement of target levels in combination with side effects or patient preference. Deprescription was facilitated when GPs had experience with patients showing increased quality of life after deprescription and was withheld by anticipated regret (ie, GPs' fear of a stroke after deprescribing). GPs felt insufficient guidance from current guidelines, especially on deprescription. CONCLUSIONS: GPs are reluctant to start or deprescribe AHM in older people and have a propensity to continue AHM within a daily routine that insufficiently supports critical medication review. (De)prescription is influenced by patient preferences and anticipated regret and current guidelines provide insufficient guidance.
Middelaar et al. (Sun,) conducted a other in Prescribing and deprescribing antihypertensive medication in older patients (n=15). Prescribing and deprescribing antihypertensive medication was evaluated on GPs' routines and considerations on (de)prescribing antihypertensive medication in older patients. General practitioners are reluctant to start or deprescribe antihypertensive medication in older people, influenced by patient preferences, anticipated regret, and insufficient guideline support.