Planned Antihypertensive Deprescribing in Long-Term Care Residents: A Systematic Review of Randomized Evidence.
Guangxiang Jiang, Guang Yang, Yixing Liu et al.
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In 30 seconds
This systematic review synthesized randomized and cluster-randomized studies of planned antihypertensive deprescribing among long-term care residents. Three studies involving 1548 residents were included, but differences in populations, deprescribing approaches, monitoring, restart criteria, and follow-up precluded meta-analysis. In DANTON, deprescribing at 16 weeks reduced antihypertensive use by 1.2 drugs (1.0-1.4) and increased systolic blood pressure by 11.0 mmHg (5.6-16.4). Mortality estimates differed across trials, and evidence for other resident-important outcomes was sparse or at risk of bias. The review concluded that a common treatment effect on mortality or other outcomes is not established.
Key findings
- Three randomized studies included 1548 long-term care residents; clinical and methodological differences prevented meta-analysis.
- In DANTON at 16 weeks, deprescribing increased systolic blood pressure by 11.0 mmHg (5.6-16.4) and diastolic pressure by 4.6 mmHg (1.1-8.1).
- DANTON reduced antihypertensive use by 1.2 drugs (1.0-1.4) at 16 weeks.
- Mortality estimates varied: RETREAT-FRAIL reported an adjusted HR of 1.02 (95% confidence interval 0.86-1.21), while DANTON reported an HR of 1.65 (0.95-2.85).
Why it matters
Long-term care residents may differ from populations informing usual antihypertensive treatment evidence because frailty, dementia, multimorbidity, and treatment burden can affect the balance of benefits and harms. This review shows that deprescribing can reduce medication exposure while raising blood pressure, but available trials do not establish the consequences for mortality or other outcomes important to residents. Trial-specific results therefore warrant cautious interpretation.
What to keep in mind
Only three studies were included, and their populations, strategies, monitoring, and follow-up differed substantially. Evidence for several resident-important outcomes was sparse, outcome-specific, or at risk of bias.