A recent study published in JAMA Network Open has found that deprescribing antihypertensive medications in long-term care residents is not associated with an increased risk of hospitalization for myocardial infarction (MI) or stroke. 

This research provides reassurance for clinicians and patients considering medication adjustments in this population.

Research Overview

The study, led by Dr. Michelle C. Odden from Stanford University, analyzed data from 13,096 U.S. veterans residing in long-term care facilities between 2006 and 2019. All participants were on at least one antihypertensive medication at the start of the study. The researchers compared health outcomes for those who had antihypertensives deprescribed with those who continued therapy.

Findings

During a 12-week observation period, 17.8% of residents had their antihypertensive medications deprescribed. Over a two-year follow-up, the unadjusted cumulative incidence of hospitalization for stroke or MI was similar between those who were deprescribed (11.2%) and those who were not (8.8%).

The study's fully adjusted models confirmed that deprescribing antihypertensive medications did not increase the risk of hospitalization for stroke or MI. The hazard ratio for stroke or MI hospitalization was 0.93 (95% confidence interval, 0.70 to 1.26), indicating no significant association.

Implications and Future Directions

The findings support the safety of deprescribing antihypertensive medications in carefully selected long-term care residents. The authors highlighted the need for further research to refine deprescribing strategies and ensure shared decision-making between patients and clinicians.

"A randomized clinical trial would help address concerns about unmeasured confounding but could be challenging to implement in this complex population," the authors noted, emphasizing the importance of evidence-based approaches to deprescribing.

This study underscores the potential to improve quality of life in elderly patients by reducing unnecessary medications without compromising cardiovascular safety.