Withdrawing antihypertensive medications in older adults

Hypertension is a significant risk factor for cardiovascular diseases, but the medications used to manage it can cause adverse reactions, particularly in older populations. This review includes six randomized controlled trials with a total of 1,073 participants aged 50 and over, evaluating the outcomes of stopping or reducing antihypertensive drugs compared to continuing them.
The meta-analysis revealed that discontinuing antihypertensive medications did not significantly impact all-cause mortality, myocardial infarction, or stroke. However, blood pressure was higher in the discontinuation group, with a mean difference of 9.75 mmHg systolic and 3.5 mmHg diastolic.
Adverse events were not significantly increased by stopping antihypertensive medications, and there was some evidence suggesting that discontinuation might resolve adverse drug reactions, though the evidence was of very low certainty. Hospitalization rates were also not significantly affected. Between 10.5% and 33.3% of participants in the discontinuation group needed to restart their medication, compared to 9% to 15% in the continuation group. The evidence suggests that withdrawing antihypertensive medications in older adults may not lead to an increase in mortality, myocardial infarction, or stroke, but it does result in higher blood pressure. More research is needed, particularly in populations with frailty and those on multiple medications, to better understand the risks and benefits of discontinuing antihypertensive therapy.