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Deprescribing Antihypertensive Drugs in Patients of Older Age Groups

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Arterial hypertension (AH) is one of the most common diseases in the elderly. It has been proven that lowering blood pressure (BP) is effective in preventing stroke and cardiovascular complications in patients even at the age of ≥80 years. On the other hand, there is evidence that a significant decrease in BP can be harmful to older people and may lead to a higher risk of overall mortality. Therefore, existing guidelines for the treatment of AH determine specific approaches for managing patients of older age groups, where the target BP levels are determined not only by age and concomitant diseases, but also by the presence of frailty. Moreover, there is a need to monitor the dynamics of frailty indicators (social, functional, cognitive and mental status of the patient), since their deterioration may require changes in the tactics of antihypertensive therapy (dose reduction, drug withdrawal or replacement) and changes in target BP levels. In this regard, in recent years, the possibility/necessity of a planned and controlled process of dose reduction, drug withdrawal or replacement, if this drug can be harmful and/or does not bring benefits (deprescribing), has attracted attention. This article is a review of current literature, which presents the design and main characteristics of randomized clinical trials (RCTs) and systematic reviews on the deprescribing of antihypertensive drugs in elderly patients with AH and frailty. An analysis of these studies showed the benefits of deprescribing of antihypertensive drugs for elderly patients with frailty, which avoids potential harm to their health, improves the quality of life and reduces the economic cost of treatment. Therefore, deprescribing of antihypertensive drugs can be used as an additional tool to achieve the necessary target BP values in patients of an older age group. However, for the development of deprescribing of antihypertensive drugs schemes and its introduction into clinical practice, the results of large specially planned RCTs are needed to study this issue.

About the Authors

O. D. Ostroumova
Russian Medical Academy of Continuing Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Olga D. Ostroumova – MD, PhD, Professor, Head of Chair of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov University

Barrikadnaya ul. 2/1, Moscow, 125993, 

Trubetskaya ul. 8-2, Moscow, 119991

M. S. Cherniaeva
Central State Medical Academy, Administrative Directorate of the President of the Russian Federation Marshala
Russian Federation

Marina S. Cherniaeva – MD, PhD, Associate Professor, Chair of Internal Medicine and Preventive Medicine

Timoshenko ul. 19, Moscow,121359

D. A. Sychev
Russian Medical Academy of Continuing Professional Education
Russian Federation

Dmitriy А. Sychev – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of Chair of Clinical Pharmacology and Therapy; Rector, Russian Medical Academy of Continuous Professional Education   

Barrikadnaya ul. 2/1, Moscow, 125993


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For citation:

Ostroumova O.D., Cherniaeva M.S., Sychev D.A. Deprescribing Antihypertensive Drugs in Patients of Older Age Groups. Rational Pharmacotherapy in Cardiology. 2020;16(1):82-93. (In Russ.)

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