OPTIMAL DRUGS FOR MEDICATION REDUCTION: SECONDARY ANALYSIS OF THE OPTIMISE MEDICATION REDUCTION TRIAL

Abstract

Objective: Deprescribing of antihypertensive medications is recommended in some elderly patients with polypharmacy and multi-morbidity. The OPTiMISE trial demonstrated that antihypertensive medication reduction can be achieved in two thirds of patients without changes in systolic blood pressure (SBP) control or serious adverse events at 12-week follow-up. The present analyses aimed to examine whether specific drug types were associated with more successful medication reduction in the intervention arm of the trial. Design and method: A total of 282 participants, aged at least 80 years with SBP < 150 mmHg and receiving 2 or more antihypertensive medications were randomised to medication reduction and included in the present analyses. Successful medication reduction was defined by the proportion of participants maintaining reduced medications. Secondary outcomes examined the association between drug class and change in SBP and adverse events. Multivariate regression analyses were conducted to examine associations adjusted for age, sex, systolic blood pressure, cardiovascular disease, multimorbidity, polypharmacy and frailty. Results: Participants included in the analysis were aged 84.6 years, with controlled hypertension (mean SBP 129.4 mmHg), polypharmacy (mean 5.4 medications) and multimorbidity (98.8% participants had 2 or more morbidities). More participants withdrawing ACE inhibitors (79.4%) and beta-blockers (80.6%) were able to maintain medication reduction more than any other drug throughout 12-week follow-up. Half (50.0%) of participants who had these medications removed experienced no increase in SBP at follow-up. In multivariate analyses, calcium channel blockers were less likely to remain withdrawn at follow-up (OR 0.31, 95% CI 0.12 to 0.86), whilst withdrawal of beta-blockers was associated with a significant reduction in SBP (-9.5 mmHg, 95% CI -16.8 to -2.1 mmHg). There was no association between removal of specific drug classes and subsequent adverse events. Conclusions: In the OPTiMISE medication reduction trial, beta-blockers were more likely to be successfully reduced and have little impact of follow-up blood pressure than any other antihypertensive drug class. When considering reducing antihypertensive medications due to polypharmacy, beta-blockers should be targeted as a first-line therapy for deprescribing, followed by ACE inhibitors in older patients with controlled hypertension.