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Deprescribing Antihypertensive Drugs in Patients of Older Age Groups

https://doi.org/10.20996/1819-6446-2020-02-14

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Abstract

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



References

1. Barnett K., Mercer S.W., Norbury M., et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:3743. DOI:10.1016/S0140-6736(12)60240-2.

2. Oganov R.G., Denisov I.N., Simanenkov V.I., et al. Comorbidities in practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017;16(6):5-56 (In Russ.) DOI:10.15829/1728-8800-2017-6-5-56.

3. Violán C., Foguet-Boreu Q., Roso-Llorach A., et al. Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study. BMC Public Health. 2014;14:530. DOI:10.1186/1471-2458-14-530.

4. Beckett N.S., Peters R., Fletcher A.E., et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887-98. DOI:10.1056/NEJMoa0801369.

5. Wright J.T. Jr., Williamson J.D., Whelton P.K., et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-16. DOI:10.1056/NEJMoa1511939.

6. McKee M., Britton A., Black N., et al. Interpreting the evidence: choosing between randomised and non-randomised studies. BMJ. 1999;319:312-5. DOI:10.1136/bmj.319.7205.312.

7. van Deudekom F.J., Postmus I., van der Ham D.J., et al. External validity of randomized controlled trials in older adults, a systematic review. PLoS One. 2017;12(3):e0174053. DOI:10.1371/journal.pone.0174053.

8. Bejan-Angoulvant T., Saadatian-Elahi M., Wright J.M., et al. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. J Hypertens. 2010;28:1366-72. DOI:10.1097/HJH.0b013e328339f9c5.

9. Benetos A., Labat C., Rossignol P., et al. Treatment with Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study. JAMA Intern Med. 2015;175(6):989-95. DOI:10.1001/jamainternmed.2014.8012.

10. Cheniaeva M.S., Ostroumova O.D., Sychev D.A. Drug-induced orthostatic hypotention. Clin Pharmacol Ther. 2018;27(5):57-63 (In Russ.) DOI:10.32756/0869-5490-2018-5-57-63.

11. Tinetti M.E., Han L., Lee D.S., et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174:588-95. DOI:10.1001/jamainternmed.2013.14764.

12. Fried T.R., Tinetti M.E., Towle V., et al. Effects of benefits and harms on older persons' willingness to take medication for primary cardiovascular prevention. Arch Intern Med. 2011;171:923-8. DOI:10.1001/archinternmed.2011.32.

13. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. DOI:10.1093/eurheartj/ehy339.

14. Chazova I.E., Zhernakova Y.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31 (In Russ.) DOI:10.26442/2075082X.2019.1.190179.

15. Fried L.P., Ferrucci L., Darer, J., et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255-63. DOI:10.1093/gerona/59.3.m255.

16. Fisher A. L. Just what defines frailty? J Am Geriatr Soc. 2005;53(12):2229-30. DOI:10.1111/j.1532-5415.2005.00510.x.

17. Benetos A., Bulpitt C.J., Petrovic M., et al. An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the management of hypertension in veryold, frail subjects. Hypertension. 2016;67:820-5. DOI:10.1161/HYPERTENSIONAHA.115.07020.

18. Thompson W., Farrell B. Deprescribing: what is it and what does the evidence tell us? Can J Hosp Pharm. 2013;66(3):201-2. DOI:10.4212/cjhp.v66i3.1261.

19. Farrell B., Pottie K., Thompson W., et al. Deprescribing proton pump inhibitors. Can Fam Physician. 2017;63(5):354-64.

20. Moonen J.E.F., Foster-Dingley J.C., de Ruijter W., et al. Effect of Discontinuation of ANtihypertensive Treatment in Elderly people on cognitive functioning (DANTE): a randomized controlled trial. JAMA Intern Med. 2015;175:1622-30. DOI:10.1001/jamainternmed.2015.4103.

21. Moonen J.E., Foster-Dingley J.C., de Ruijter W., et al. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden. Age Ageing. 2016;45(2):249-55. DOI:10.1093/ageing/afv199.

22. Gulla C., Flo E., Kjome R.L., Husebo B.S. Deprescribing antihypertensive treatment in nursing home patients and the effect on blood pressure. J Geriatr Cardiol. 2018;15(4):275-83. DOI:10.11909/j.issn.1671-5411.2018.04.011.

23. van der Wardt V., Harrison J.K., Welsh T., et al. Withdrawal of antihypertensive medication: a systematic review. J Hypertens. 2017;35(9):1742-9. DOI:10.1097/HJH.0000000000001405.

24. Rodríguez-Pérez A., Alfaro-Lara E.R., Albiñana-Perez S., et al. Novel tool for deprescribing in chronic patients with multimorbidity: List of Evidence-Based Deprescribing for Chronic Patients criteria. Geriatr Gerontol Int. 2017;17(11):2200-7. DOI:10.1111/ggi.13062.

25. Sheppard J.P., Burt J., Lown M., et al. OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE): protocol for a randomised controlled noninferiority trial. BMJ Open. 2018;8(9):e022930. DOI:10.1136/bmjopen-2018-022930.

26. Benetos A. How to obtain more evidence for the management of hypertension in frail patients over 80 years old? European Geriatric Medicine. 2018;9(2):137-40. DOI:10.1007/s41999-0180035-5.

27. Tkacheva O.N., Runikhina N.K., Kotovskaya Y.V., et al. Arterial hypertension management in patients aged older than 80 years and patients with the senile asthenia. Cardiovascular Therapy and Prevention. 2017;16(1):8-21 (In Russ.) DOI: 10.15829/1728-88002017-1-8-21.

28. Clinical recommendations. Frailty. Russian Association of Gerontologists and Geriatrics (2018). [cited by Aug 08, 2019]. Available fron: http://yakmed.ru/wp-content/uploads/2018/07/Asteniya_recomend.pdf. (In Russ.)

29. O'Mahony D., O'Sullivan D., Byrne S., et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213-8. DOI:10.1093/ageing/afu145.

30. Mallery L.H., Allen M., Fleming I., et al. Promoting higher blood pressure targets for frail older adults: a consensus guideline from Canada. Cleve Clin J Med. 2014;81(7):427-37. DOI:10.3949/ccjm.81a.13110.

31. Fernandez P.G., Kim B.K., Galway A.B., Sharma J.N. Separation of essential hypertensive patients based on blood pressure responses after the withdrawal of antihypertensive agents by step-wise discriminant analysis. Curr Med Res Opin. 1983;8:509-17. DOI:10.1185/03007998309109790.

32. Nelson M.R., Reid C.M., Krum H., et al. Predictors of normotension on withdrawal of antihypertensive drugs in elderly patients: prospective study in second Australian national blood pressure study cohort. BMJ. 2002;325(7368):815. DOI:10.1136/bmj.325.7368.815.

33. Fotherby M.D., Potter J.F. Possibilities for antihypertensive drug therapy withdrawal in the elderly. J Hum Hypertens. 1994;8:857-63.


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.) https://doi.org/10.20996/1819-6446-2020-02-14

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ISSN 1819-6446 (Print)
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