From the Guidelines
Antihypertensive medication should be continued lifelong, even beyond the age of 85 years, if well tolerated, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. When considering discontinuation of antihypertensive medication, treatment decisions should be individualized based on the patient's overall health status, frailty, comorbidities, life expectancy, and goals of care rather than age alone. Some key factors to consider include:
- The presence of orthostatic hypotension, which may require testing by measuring blood pressure 1 and/or 3 min after standing, and potentially switching to alternative BP-lowering therapies that do not worsen orthostatic hypotension 1
- The patient's tolerance of the medication, with consideration of potential side effects such as falls, electrolyte disturbances, and other medication-related harms
- The patient's preferences and quality of life, which should be balanced against the cardiovascular risk reduction benefits of continued antihypertensive therapy For older adults, clinicians should consider a less aggressive blood pressure target and medication regimens may need adjustment to minimize side effects. Regular monitoring becomes increasingly important with age to assess medication effectiveness, side effects, and adherence. If a patient develops significant frailty, has limited life expectancy, or experiences troublesome side effects, gradual deprescribing with careful monitoring may be appropriate, as supported by previous guidelines such as the 2011 Hypertension Guideline and the HYVET study 1.
From the Research
Discontinuation of Antihypertensive Medication
There is no specific age at which antihypertensive medication is discontinued, as the decision to stop treatment depends on various factors, including the patient's overall health, comorbidities, and blood pressure control.
- The study 2 suggests that deprescribing antihypertensive drugs can be considered in frail older adults, but it is essential to weigh the benefits and harms of treatment and consider other indications for which the medication may have been prescribed.
- Another study 3 found that only a limited portion of antihypertensive patients could stop their medication successfully over 6 months, highlighting the need for careful selection of eligible patients and continuous emotional support.
- The review 4 provides guidance on identifying suitable patients for deprescribing antihypertensive medications, including those with cognitive impairment, frailty, or well-controlled blood pressure.
- The study 5 and review 6 emphasize the importance of individualized treatment decisions, considering the benefits and risks of antihypertensive medications in older adults, particularly those with multimorbidity or limited life expectancy.
Factors Influencing Discontinuation
Several factors influence the decision to discontinue antihypertensive medication, including:
- Patient's overall health and comorbidities 2, 4
- Blood pressure control and risk of cardiovascular disease 5, 6
- Presence of cognitive impairment or frailty 4
- Patient's preferences and values 3
- Potential risks associated with treatment, such as orthostatic hypotension, falls, and fractures 6
Considerations for Deprescribing
When considering deprescribing antihypertensive medication, healthcare providers should:
- Carefully evaluate the patient's individual circumstances and medical history 2, 4
- Monitor blood pressure and adjust treatment as needed 5, 3
- Provide patient education and support to ensure successful deprescribing 3, 4
- Weigh the benefits and harms of treatment, considering the patient's quality of life and life expectancy 2, 6