DB-2-4: NO, WE SHOULD NOT STOP ANTIHYPERTENSIVE MEDICATIONS FOR END-OF-LIFE PATIENTS WITH HYPERTENSION

Abstract

End-of-life patients, the Debate theme, are sometimes described as patients with limited life expectancy. Even if one is under the impression that death shortly is inevitable for the patient in front of them due to a specific disease, the duration of life expectancy varies and is difficult to estimate. Factors affecting the period of life expectancy are complicated, including the causative disease, comorbidities, the environment of care, and the individual's physical and mental capacity. Although high blood pressure does not directly affect life expectancy, hypertension affects life expectancy, quality of life, and ADL through the development or exacerbation of stroke, cardiovascular disease, and renal failure. This situation is the same even for end-of-life individuals, who are at high risk of hypertensive complications if their hypertension is poorly controlled. Worsened blood pressure control increases the risk of stroke and heart failure, even within a few months. The VALUE trial found a significant difference in the incidence of events within the first six months after randomization to the two treatment groups. This difference in event rate was attributed to differences in blood pressure levels between the two groups during that period. The VALUE trial did not include end-of-life patients. Still, it can be assumed that even in end-of-life patients, an increase in blood pressure due to withdrawal of antihypertensive medication may increase the incidence of events within a few months. Of course, deprescribing may be acceptable if blood pressure is still controlled within a level less than 140/90. However, there are currently no randomized controlled trials on the effects of such reduction of antihypertensive drugs. There have been several studies and systematic reviews on whether overall withdrawal of therapeutic drugs should be undertaken for end-of-life patients, not specific to antihypertensive medications. None of these studies has reached a clear conclusion in favor of drug treatment withdrawal. In the most plausible conclusion, “We should not stop antihypertensive medications for end-of-life patients with hypertension.”