Antihypertensive Deprescribing in Long-term Care

• Status: Enrolling by invitation
• Trial end date: 2024-06-30
• Target enrollment: 0
• Participant gender: All

Summary

Frail older adults are commonly prescribed blood pressure medication, yet it is unclear if blood pressure medication is actually beneficial for them. Observational studies in this population suggest blood pressure medication has limited benefit and may even be harmful, including an increased risk for falls and cognitive impairment. Randomized controlled trials are needed to confirm this.

This study is a randomized controlled trial of blood pressure medication deprescribing, amongst long-term care residents with systolic blood pressure lower than 135 mmHg. In the intervention group, with physician consent, the facility pharmacist will reduce blood pressure medication until the blood pressure reaches the target systolic blood pressure of 140 ±5 mmHg. The control group will receive usual care. The primary outcome is all-cause mortality but the study will also be tracking all-cause hospitalization or emergency room visits, hip fractures, cost of medication, and quality of life.

The hypothesis is that avoiding unnecessarily low systolic blood pressure is beneficial in a frail, end-of-life population.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Alberta
• Collaborator: Alberta Health Services
• Treatments: Antihypertensive Agents

Criteria

Inclusion Criteria:

• ≥2 diagnoses (dx) of hypertension from either a community practitioner or/and from a hospital admission;

• on ≥1 oral antihypertensive medication; and

• average recorded systolic BP of <135 mmHg.

Exclusion Criteria:

• ≥2 community dx of congestive heart failure, ≥1 dx of in hospital congestive heart failure, ≥1 dx of emergency visit of congestive heart failure, or prescription of furosemide in the last month;

• ≥2 community dx of benign prostate hypertrophy or ≥1 dx of in hospital benign prostate hypertrophy and the only antihypertensive prescribed in the last month is an alpha blocker;

• ≥2 community dx of essential tremor or ≥1 dx of in hospital essential tremor and the only antihypertensive prescribed in the last month is a beta blocker;

• ≥2 community dx of a migraine or ≥1 dx of in hospital migraine and the only antihypertensive prescribed in the last month is a beta blocker;

• ≥2 community dx of tachycardia/atrial fibrillation or ≥1 dx of in hospital tachycardia/atrial fibrillation and the only antihypertensive prescribed in the last month is a beta blocker and/or a calcium channel blocker;

• ≥2 community dx of coronary artery disease or ≥1 dx of in hospital coronary artery disease and the only antihypertensive prescribed in the last month is a beta blocker and/or a calcium channel blocker;

• the resident's physician declines to participate in the study; or

• the resident or legal guardian declines to participate in the study.