Is Blood Pressure Control Possible with Medication Reduction in Older Patients?

Sarfaroj Khan 

June 17, 2020

Takeaway

  • Medication reduction in older patients treated with multiple antihypertensive medications was noninferior to usual care with regard to the proportion of patients with systolic blood pressure (SBP) lower than 150 mmHg at 12 weeks.

Why this matters

  • Findings suggest that antihypertensive medication reduction can be achieved in some older patients with hypertension without substantial change in blood pressure (BP) control.

Study design

  • This noninferiority OPTIMISE trial included 569 participants (mean age, 84.8 years; median of 2 antihypertensive medications prescribed at baseline) randomly assigned to a strategy of antihypertensive medication reduction (intervention group; n=282) or usual care (control group; n=287).

  • Primary outcome: SBP <150 mmHg at 12-week follow-up.

  • Funding: National Institute for Health Research.

Key results

  • Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had a SBP <150 mmHg at 12 weeks (adjusted relative risk, 0.98; 97.5% 1-sided CI, 0.92 to ∞), a difference that met the noninferiority margin of a relative risk of 0.90.

  • At 12 weeks, medication reduction was maintained in 187 (66.3%) participants in the intervention group.

  • Mean change in SBP (adjusted mean difference, 3.4 [95% CI, 1.0-5.8] mmHg; P=.005) and diastolic BP (adjusted mean difference, 2.2 [95% CI, 0.9-3.6] mmHg; P=.001) was higher in the intervention group vs. the control group.

  • Overall, 12 (4.3%) participants in the intervention group and 7 (2.4%) in the control group reported ≥1 serious adverse event (adjusted risk ratio, 1.72; 95% CI, 0.68-4.29).

  • No statistically significant differences were observed between groups in frailty, quality of life, adverse effects, or serious adverse events at follow-up.

Limitations

  • Participants were selected based on the primary care physician’s view.

  • Unblinded design.

Sheppard JP, Burt J, Lown M, Temple E, Lowe R, Fraser R, Allen J, Ford GA, Heneghan C, Hobbs FDR, Jowett S, Kodabuckus S, Little P, Mant J, Mollison J, Payne RA, Williams M, Yu LM, McManus RJ. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. JAMA. 2020;323(20):2039-2051. doi: 10.1001/jama.2020.4871. PMID: 32453368.  Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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