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According to research published on 26 May, 2020, GPs can safely reduce the number of antihypertensive medications taken by some older people without substantial changes to blood pressure control. 

The research took place at the Universities of Oxford, Cambridge and Southampton and was co-funded by the NIHR ARC Oxford and the NIHR School for Primary Care Research.

The press release Less is more? Deprescribing blood pressure lowering medications is safe in the short-term in older people with frailty and multiple long-term conditions explains that, with lockdown measures in place, fewer patients are seeing their doctor for check-ups and management of their chronic conditions.  optimise

One area likely to be neglected is polypharmacy – taking multiple medications for multiple conditions – which is common in older people and can be complicated to manage. Polypharmacy cannot be ignored, as it may increase the risk of side effects to medications due to harmful drug interactions. As such, particularly in older patients prescribed multiple medications, it is generally desirable to regularly review whether these all need to be continued.

The research shows that in some older people it is possible for GPs to reduce the number of blood pressure lowering medications people take with limited impact on their blood pressure control or quality of life. The trial showed over a period of 12 weeks, blood pressure remained well controlled (150 mm Hg or less) in 86.4% of patients in the medication reduction arm and 87.7% of patients in the usual care arm, with two thirds of those in the medication reduction group taking fewer medications at the end of the study.

Dr Jenni Burt, Senior Social Scientist at the University of Cambridge’s Primary Care Unit said: “During this pandemic, it is vital that chronic conditions such as hypertension continue to be managed and medicines reviewed for their appropriateness. More than half of patients aged 80 or older will have high blood pressure, and many of them may be taking two or more different drugs to control it. Since blood pressure medications are prescribed for prevention rather than to alleviate symptoms, they are an ideal target for reducing polypharmacy, particularly when the benefits of continued treatment might not outweigh the harms.”

Dr James Sheppard, University Research Lecturer at Oxford University’s Nuffield Department of Primary Care Health Sciences, and co-chief investigator on the study, said: “Blood pressure medications are proven to reduce a person’s risk of stroke and heart attack, but for some, they may also cause fainting and falls or kidney problems, so called ‘adverse events’. This trial shows that when someone is concerned about the risk of adverse events, it is possible to reduce the number of tablets being taken and still achieve good blood pressure control, which is important for preventing stroke.”