Authors:
Keturah Weaver Pharm D, BCPS
Daniel Longyhore Pharm D, M.S., BCACP

Reviewers:
Sara Wettergreen, PharmD, BCACP
J. Ben Hill, PharmD
Kristin Rieser, PharmD, BCACP

CITATION: Sheppard JP, Burt J, Lown M, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. JAMA. 2020;323(20):2039–2051.

The Problem

How often do you recommend stopping a medication being used for a stable chronic condition? Health care professionals often don’t think twice about adding a new medication when a patient is not at goal. But we’re reluctant to stop a medication for a chronic condition when the patient appears to be stable and doing well. Does the patient have high cholesterol? Add a statin. Does the patient have type 2 diabetes? It’s time to start metformin. Is the patient’s blood pressure at target? Let’s discontinue one of their medications…what? Polypharmacy in older adults is a significant problem.  It’s costly and increases the likelihood of adverse effects. Several observational studies have suggested that lower blood pressure and multiple antihypertensive medications may be harmful in the elderly.1-3 Is it possible to discontinue medications without causing serious harm?

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