Strategy for Depressing Antihypertensive Drugs in Very Elderly and Fragile Patients: A Review of Contemporary Data

Antihypertensive drugs reduce the risk of stroke and cardiovascular disease in all age groups. However, in elderly and frail patients, antihypertensive treatment is associated with an increased risk of hypotension, syncope, acute kidney injury and hyperkalemia; in these patients, the risk of AEs may outweigh the benefits of antihypertensive treatment, and drug withdrawal is proposed to reduce this risk. The concept of controlled withdrawal of antihypertensive drugs is new and many practical aspects require further study in randomized controlled trials to determine the longterm effects on important clinical outcomes and quality of life in elderly patients. Given the limited evidence on long-term outcomes of controlled withdrawal of antihypertensive drugs, it must be recognized that withdrawal of antihypertensive drugs is an area of limited evidence, with very few clinical trials assessing long-term clinical effects. This review examines the rationale and potential barriers to the implementation of controlled withdrawal of antihypertensive drugs in the elderly. Recommendations for identifying patients at high risk of adverse events and a deprescribing algorithm are provided.