Unclear Whether Antihypertensive Medication Withdrawal Harms Older Adults

A recent Cochrane review cited by Medscape investigated whether withdrawal of antihypertensive medications has adverse consequences in more than 1,000 individuals aged 50 years and older across six randomized controlled trials. Compared with the groups that continued antihypertensive medication, the discontinuation groups had higher odds of all-cause mortality, myocardial infarction, and stroke. But the certainty of evidence was low and none of the differences were statistically significant. Systolic blood pressure and diastolic blood pressure were both significantly higher in the discontinuation groups. Also, more participants in the discontinuation groups experienced increased blood pressure or other clinical criteria that would require restarting of therapy or removal from the study. However, many of the studies in the review had limitations including selective reporting, incomplete outcome data, and lack of blinding of participants and personnel. These limitations "mean that we cannot make any firm conclusions about the effect of deprescribing antihypertensives on these outcomes," the authors conclude. "Older adults should not stop any of their medications without talking to a health care professional."