Can some older adults safely lower their blood pressure medication?

A randomized trial found that some people aged 80 and above were able to keep their blood pressure controlled for 12 weeks after a doctor stopped one of their blood pressure medicines.

Researchers at the University of Oxford say the findings suggest that, for carefully chosen patients and with close medical oversight, reducing medication may be possible. However, the study does not show that all older adults can safely take fewer drugs, nor does it reveal the long-term effects.

The trial enrolled 569 participants whose systolic blood pressure was below 150 mmHg. Each person was taking at least two blood pressure medicines, and their doctors judged a reduction to be potentially suitable.

People were randomly assigned either to stay on their current treatment or to have one medicine withdrawn under supervision. The team rechecked blood pressure after 12 weeks and used a safety plan that allowed treatment to be restarted if necessary.

By the end of the study, 86.4% of those in the reduction group and 87.7% of those receiving usual care still had systolic blood pressure below 150 mmHg. Systolic pressure is the top number in a blood pressure reading.

The reduction approach met the trial’s predefined standard for being close enough to usual care on that short-term measure. Even so, the average systolic reading was about 3.4 mmHg higher in the group that reduced medication.

For related reading on follow-up outside the clinic, see research into structured home blood pressure monitoring.

Roughly two-thirds of the reduction group were still on fewer blood pressure medicines after 12 weeks. Others had restarted treatment or did not keep the reduction for another reason.

Serious side effects were rare, but the study was too small and too short to determine whether reducing medication affects the risk of heart attack, stroke or death. The limited number of events also restricts conclusions about safety.

The study, published in JAMA, was led by James Sheppard and colleagues. It focused on selected patients with controlled blood pressure, not all older adults taking multiple medicines.

Blood pressure treatment can lower the risk of serious cardiovascular disease. At the same time, age, other medical conditions, side effects and the medicines involved all influence the balance of benefits and risks.

The researchers used a single blood pressure threshold chosen for the trial. A suitable target can vary depending on a person’s circumstances, and the results should be considered within the study’s eligibility criteria.

The trial compared a structured reduction strategy with continuing usual care. It did not test whether cutting back on every type of blood pressure medicine has the same effect, or whether patients should make changes on their own.

The findings point to the need for more research on when a supervised reduction may be appropriate. Decisions about prescription medicines require individual assessment and monitoring; this study was not a test of stopping treatment without medical guidance.

If you are interested in this topic, please read articles about This food linked to better heart health and blood pressure in older adults, and The worst foods for high blood pressure in older people.

For more information, please see articles about Why beetroot juice could help lower blood pressure in older people, and What should know about high blood pressure drugs and their side effects.

Source: University of Oxford.