CLINICAL QUESTION

Can antihypertensive drugs be safely discontinued in adults 50 years and older without increasing the risk of major adverse health outcomes, such as death, stroke, or hospitalization?

EVIDENCE-BASED ANSWER

Discontinuing antihypertensive drugs in adults 50 years and older may lead to a modest increase in blood pressure but does not significantly increase the risk of all-cause mortality, stroke, myocardial infarction, or hospitalization rates.¹ (Strength of Recommendation: B, limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Antihypertensive drugs are effective in reducing cardiovascular disease, end-stage kidney disease, and all-cause mortality; however, they can cause adverse effects and contribute to polypharmacy in adults.² Withdrawing, or deprescribing, antihypertensive drugs may reduce adverse effects, particularly in older adults who are more prone to adverse effects and the risks associated with polypharmacy.³

This Cochrane review included six randomized controlled trials that evaluated the clinical impact of discontinuing vs continuing antihypertensive drugs in adults 50 years and older (mean age = 58–82 years) who were taking them for hypertension or for the primary prevention of cardiovascular disease.¹ A lower age threshold of 50 years was selected to include older studies and broaden applicability to clinical circumstances where earlier-than-expected aging may be relevant. Patients were excluded if their antihypertensive drugs were prescribed for secondary prevention after diagnoses (eg, with myocardial infarction, heart failure, chronic kidney disease).