Withdrawal of antihypertensive drugs in older people | Figure 1

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Withdrawal of antihypertensive drugs in older people

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Aim

This review aimed to find out if it is possible to stop blood pressure medications in older people. We also wanted to find out the effects of stopping these medications.

We included adults aged 50 years and over who were taking blood pressure medications for high blood pressure (hypertension) or for prevention of heart diseases (primary prevention). We excluded studies with people who had previously had a heart attack, stroke or other heart disease (secondary prevention).

We compared stopping or reducing the dose of blood pressure medications with continuing blood pressure medications.

Background

High blood pressure, also known as hypertension, is a risk factor for many diseases, such as heart attack, kidney failure and stroke. While hypertension usually produces no symptoms, keeping blood pressure under control is vital for preserving health and reducing the risk of serious conditions.

Hypertension is often managed with lifestyle and blood pressure (antihypertensive) medications. There are many different types of blood pressure medications available.

Antihypertensives can cause dangerous side effects, such as dizziness and fatigue which might lead to falls. Older people are at greater risk of medication side effects compared to younger people. It is unclear whether the benefits of antihypertensive medications outweigh the harms in older people.

Study characteristics

Our search to April 2019 found six studies, including 1,073 older adults in total. People in the studies had an average age of 58 to 82 years. In three of the studies, the dose of the antihypertensive was slowly lowered before stopping.

Key results

We found that stopping antihypertensive medications is possible in older adults. Most of the older people in the discontinuation groups did not need to restart their medication.

We found low certainty of evidence that stopping antihypertensive medication increased blood pressure by a small amount.

We found low or very low certainty of evidence that stopping blood pressure medications did not increase the risk of having a heart attack, stroke, hospitalisation or death.

We found very low certainty of evidence that stopping blood pressure medications did not increase the risk of adverse events and may resolve side effects, but this was not reported well, and so we were unable to draw conclusions.

None of the studies reported whether stopping blood pressure medications affected falls.

Certainty of the evidence

We rated the certainty of the evidence using four levels: very low, low, moderate, or high. High certainty evidence means that we are very confident in the results. Very low certainty evidence means that we are very uncertain about the results. We judged the certainty of evidence as very low and low.

Conclusion

It may be safe to stop antihypertensive medications in older people who are taking the medication for high blood pressure or primary prevention of heart disease.

Older adults should not stop any of their medications without talking to a healthcare professional.

Future studies should include older adults who are taking multiple other medications and/or living with frailty.

Read the full Cochrane Review here

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