Medication Reduction: Age 80 years and older

Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and OlderThe OPTIMISE Randomized Clinical Trial

James P. Sheppard, PhD¹; Jenni Burt, PhD²; Mark Lown, MRCGP³; et alEleanor Temple, BSc¹; Rebecca Lowe, BSc¹; Rosalyn Fraser, MSc¹; Julie Allen, BSc¹; Gary A Ford, MB, BChir⁴; Carl Heneghan, DPhil¹; F. D. Richard Hobbs, MBChB¹; Sue Jowett, PhD⁵; Shahela Kodabuckus, MSc⁵; Paul Little, MD⁶; Jonathan Mant, MD⁷; Jill Mollison, PhD¹; Rupert A. Payne, MRCGP⁸; Marney Williams, BEd⁹; Ly-Mee Yu, DPhil¹; Richard J. McManus, PhD¹; for the OPTIMISE Investigators

Author Affiliations Article Information

JAMA. 2020;323(20):2039-2051. doi:10.1001/jama.2020.4871

Key Points

Question  Among older adults taking multiple antihypertensive medications, is a strategy of antihypertensive medication reduction noninferior to usual care with regard to short-term blood pressure control?

Findings  In this randomized clinical trial that included 569 patients aged 80 years and older, the proportion with systolic blood pressure lower than 150 mm Hg at 12 weeks was 86.4% in the intervention group and 87.7% in the control group (adjusted relative risk, 0.98), a difference that met the noninferiority margin of a relative risk of 0.90.

Meaning  The findings suggest antihypertensive medication reduction can be achieved without substantial change in blood pressure control in some older patients with hypertension.

Abstract