{"id":5246,"date":"2026-04-16T02:36:52","date_gmt":"2026-04-16T02:36:52","guid":{"rendered":"http:\/\/homecares.net\/?p=5246"},"modified":"2026-04-16T02:36:52","modified_gmt":"2026-04-16T02:36:52","slug":"deprescribing-antihypertensives-in-older-nursing-home-residents-a-landmark-study-challenges-conventional-wisdom","status":"publish","type":"post","link":"https:\/\/homecares.net\/?p=5246","title":{"rendered":"Deprescribing Antihypertensives in Older Nursing Home Residents: A Landmark Study Challenges Conventional Wisdom"},"content":{"rendered":"<p>The complex landscape of medication management for older adults, particularly those in nursing home settings, is undergoing a critical re-evaluation, highlighted by a groundbreaking study published in the <em>New England Journal of Medicine<\/em>. This research, led by Dr. Athanase Benetos, a geriatrician researcher at the University Hospital of Nancy Lorraine and senior researcher at the National Institute of Biomedical Research in France, investigated the practice of deprescribing antihypertensive medications in very old and frail individuals. The study challenges long-held assumptions about the benefits of aggressive blood pressure control in this vulnerable population and underscores the importance of individualized care.<\/p>\n<p>The impetus for this extensive research stems from decades of clinical observation and a growing body of evidence suggesting that the prevailing guidelines for hypertension management, often derived from studies of younger, healthier populations, may not be universally applicable to the elderly, especially those with multiple comorbidities and significant frailty. Historically, individuals residing in nursing homes have been systematically excluded from clinical trials due to their complex health profiles. This exclusion has created a significant knowledge gap, leaving clinicians with limited evidence to guide treatment decisions for this demographic.<\/p>\n<p>Dr. Benetos, whose background spans cardiology and geriatrics, noted the increasing prevalence of older patients with hypertension in his practice. &quot;Progressively we had more and more older patients in our department,&quot; he explained. &quot;And then the question was, in people with a lot of comorbidities, frailty, a lot of other medication, the question was, could we understand really if it was the same thing that was being done with other younger patients or even older patients, but not with all these problems.&quot; This clinical dilemma, coupled with the observation that frail older adults often bear the highest burden of polypharmacy, including multiple antihypertensive medications, fueled the desire to conduct a rigorous investigation into deprescribing.<\/p>\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_82_2 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/homecares.net\/?p=5246\/#The_Growing_Debate_Around_Hypertension_Management_in_the_Elderly\" >The Growing Debate Around Hypertension Management in the Elderly<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/homecares.net\/?p=5246\/#Designing_a_Landmark_Randomized_Controlled_Trial\" >Designing a Landmark Randomized Controlled Trial<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/homecares.net\/?p=5246\/#Unveiling_the_Results_No_Difference_in_Overall_Mortality_but_Nuances_Emerge\" >Unveiling the Results: No Difference in Overall Mortality, but Nuances Emerge<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/homecares.net\/?p=5246\/#The_Frailty_Factor_A_Deeper_Dive_into_Subgroup_Analysis\" >The Frailty Factor: A Deeper Dive into Subgroup Analysis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/homecares.net\/?p=5246\/#Reactions_and_Implications_Shifting_Paradigms_in_Geriatric_Care\" >Reactions and Implications: Shifting Paradigms in Geriatric Care<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/homecares.net\/?p=5246\/#Future_Directions_and_Clinical_Takeaways\" >Future Directions and Clinical Takeaways<\/a><\/li><\/ul><\/nav><\/div>\n<h3><span class=\"ez-toc-section\" id=\"The_Growing_Debate_Around_Hypertension_Management_in_the_Elderly\"><\/span>The Growing Debate Around Hypertension Management in the Elderly<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The treatment of hypertension in older adults has been a subject of evolving medical discourse. While aggressive blood pressure control has been a cornerstone of cardiovascular disease prevention in the general population, its application in the very old and frail has become increasingly nuanced. Landmark studies like the Systolic Blood Pressure Intervention Trial (SPRINT), while demonstrating significant cardiovascular benefits for lowering systolic blood pressure to below 120 mmHg in a population aged 50 and older, notably excluded individuals in nursing homes. This exclusion, among others, meant that the optimal blood pressure targets and the potential risks and benefits of antihypertensive therapy in this specific, highly vulnerable group remained largely undefined.<\/p>\n<p>Observational studies, including the Partage study conducted by Dr. Benetos&#8217;s team and others, had previously indicated a potential for increased mortality in nursing home residents over 80 years old with treated hypertension and systolic blood pressure below 130 mmHg. However, observational data are inherently limited in establishing causality. These studies could not definitively determine whether the low blood pressure was a cause of increased mortality or merely a marker of underlying illness and frailty. This ambiguity necessitated a more robust, interventional approach.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Designing_a_Landmark_Randomized_Controlled_Trial\"><\/span>Designing a Landmark Randomized Controlled Trial<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>To address these critical questions, Dr. Benetos and his colleagues designed a randomized controlled trial to specifically evaluate the impact of deprescribing antihypertensive medications in nursing home residents. The study, published in the prestigious <em>New England Journal of Medicine<\/em>, meticulously selected participants to reflect the realities of care for the elderly in long-term facilities.<\/p>\n<p><strong>Key inclusion criteria for the study included:<\/strong><\/p>\n<ul>\n<li><strong>Age:<\/strong> Over 80 years old.<\/li>\n<li><strong>Antihypertensive Medication:<\/strong> Receiving at least two different antihypertensive drugs.<\/li>\n<li><strong>Blood Pressure:<\/strong> A low systolic blood pressure, defined as less than 130 mmHg.<\/li>\n<\/ul>\n<p>The rationale for focusing on nursing homes was to capture the population most representative of frailty and polypharmacy, groups historically underrepresented in clinical research. Furthermore, the study took significant steps to ensure ethical conduct and maximize participation, acknowledging the challenges of obtaining informed consent from this population. Patients were required to provide consent, and when a patient was unable to do so, consent was obtained from a family member or a designated trusted person. The study aimed for broad inclusion, with the only significant exclusion criterion being a compelling indication for a specific antihypertensive medication due to another coexisting medical condition that necessitated its use. This approach ensured that the findings would be highly relevant to real-world clinical practice.<\/p>\n<p>The intervention involved two groups: an intervention group where physicians were guided to reduce or stop antihypertensive medications, and a control group where treatment continued as usual. The deprescribing strategy followed a carefully considered order, prioritizing the discontinuation of medications generally considered to have a higher risk of side effects or less established efficacy as first-line agents in older adults. This order, determined by a scientific committee, began with central antihypertensive drugs, followed by loop diuretics, then non-dihydropyridine calcium channel blockers and beta-blockers, and finally ARBs, ACE inhibitors, and thiazides, with dihydropyridine calcium channel blockers being the last considered for deprescribing. This systematic approach aimed to balance the potential benefits of reducing medication burden with the risks of uncontrolled blood pressure.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Unveiling_the_Results_No_Difference_in_Overall_Mortality_but_Nuances_Emerge\"><\/span>Unveiling the Results: No Difference in Overall Mortality, but Nuances Emerge<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>After a median follow-up of over three years, the study revealed a striking absence of a significant difference in the primary outcome, all-cause mortality, between the deprescribing group and the control group. This finding, while potentially counterintuitive given the observational data suggesting harm from low blood pressure in this population, has profound implications for clinical practice.<\/p>\n<p><strong>Key Findings:<\/strong><\/p>\n<ul>\n<li><strong>No Significant Difference in All-Cause Mortality:<\/strong> The primary endpoint of the study showed no statistically significant difference between the group where antihypertensive medications were deprescribed and the control group.<\/li>\n<li><strong>COVID-19 Mortality Discrepancy:<\/strong> A notable exception emerged in the analysis of mortality due to COVID-19. The deprescribing group experienced approximately three times fewer deaths from COVID-19 compared to the control group, a finding that is currently under further investigation to understand potential underlying mechanisms.<\/li>\n<li><strong>No Difference in Other Pre-specified Endpoints:<\/strong> Other pre-specified secondary endpoints, including functional status, cognitive function, and falls, also showed no significant differences between the two groups.<\/li>\n<li><strong>Reduced Medication Burden:<\/strong> The intervention group successfully achieved a reduction in the number of antihypertensive medications and a slight, though statistically significant, increase in systolic blood pressure compared to the control group.<\/li>\n<\/ul>\n<p>The lack of a significant difference in overall mortality has been interpreted by the researchers and independent experts as evidence of non-inferiority, suggesting that deprescribing antihypertensives in this specific frail population, when managed carefully, does not lead to increased harm in terms of mortality. This is a crucial finding, as it implies that reducing medication burden, associated costs, and potential side effects might be achievable without compromising patient safety regarding mortality.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"The_Frailty_Factor_A_Deeper_Dive_into_Subgroup_Analysis\"><\/span>The Frailty Factor: A Deeper Dive into Subgroup Analysis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>While the overall mortality figures were similar, a compelling trend emerged from the subgroup analysis based on the patients&#8217; level of frailty. The study categorized participants using the Clinical Frailty Scale, revealing a differential response to deprescribing.<\/p>\n<ul>\n<li><strong>&quot;Fit&quot; or Robust Patients:<\/strong> In the approximately 10% of patients who were classified as robust or fit, there was a non-significant trend towards increased benefit (i.e., lower mortality) from continuing antihypertensive treatment. This finding aligns with existing evidence from studies like SPRINT, suggesting that more robust older adults may indeed benefit from more aggressive blood pressure management.<\/li>\n<li><strong>&quot;Frail&quot; or Vulnerable Patients:<\/strong> Conversely, in the most severely frail patients (approximately 40% of the study population), there was a non-significant but notable trend towards greater benefit from deprescribing antihypertensive medications. This suggests that for the most vulnerable individuals, the risks associated with antihypertensive therapy and polypharmacy may outweigh the benefits of strict blood pressure control.<\/li>\n<\/ul>\n<p>This nuanced finding highlights the critical importance of individualizing treatment decisions based on a patient&#8217;s specific level of frailty and functional status, rather than applying a one-size-fits-all approach.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Reactions_and_Implications_Shifting_Paradigms_in_Geriatric_Care\"><\/span>Reactions and Implications: Shifting Paradigms in Geriatric Care<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The study&#8217;s findings have been met with considerable interest and discussion within the geriatric and cardiovascular communities. Dr. Mike Steinman, a geriatrician researcher at UCSF and co-PI of the US Deprescribing Research Network, who was not involved in the study but participated in the podcast discussion, emphasized the value of this research. &quot;Deprescribing ain&#8217;t pharma. It takes a lot of money,&quot; he stated, acknowledging the financial and logistical challenges of conducting such trials. However, he underscored that &quot;providing more direct evidence is useful&quot; and that empirical evaluation is essential.<\/p>\n<p>Dr. Steinman further elaborated on the concept of &quot;healthy survivor bias,&quot; where individuals who have tolerated medications for extended periods are inherently less likely to have experienced severe adverse effects. This phenomenon, along with potential physiological adaptations to long-term medication use, could explain why outcomes might differ between starting a drug and stopping it.<\/p>\n<p>The comparison with the Danton study, which investigated deprescribing in nursing home residents with dementia, revealed some key differences. The Danton study, which was stopped early due to worsening side effects and no improvement in quality of life, included patients with higher baseline blood pressure targets (up to 160 mmHg) and a more rapid deprescribing schedule. Dr. Benetos pointed out that these methodological distinctions likely contributed to the differing results, emphasizing that deprescribing, much like prescribing, requires careful patient assessment, a gradual approach (&quot;start low, go slow&quot;), and continuous follow-up.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Future_Directions_and_Clinical_Takeaways\"><\/span>Future Directions and Clinical Takeaways<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>The implications of this study are far-reaching for clinicians caring for older adults in nursing homes and other long-term care settings.<\/p>\n<ul>\n<li><strong>Individualized Approach:<\/strong> The most significant takeaway is the imperative to individualize hypertension management based on a patient&#8217;s overall health status, frailty, functional level, and personal values.<\/li>\n<li><strong>Cautious Deprescribing:<\/strong> For frail and very old individuals, especially those with multiple comorbidities, deprescribing antihypertensives, when done thoughtfully and with careful monitoring, appears to be a safe and potentially beneficial strategy, particularly in reducing medication burden and potentially mitigating risks.<\/li>\n<li><strong>Revisiting Blood Pressure Targets:<\/strong> The study adds weight to the growing consensus that current aggressive blood pressure targets may not be appropriate for all older adults, especially the frail.<\/li>\n<li><strong>Focus on Harm Reduction:<\/strong> While not showing a reduction in overall mortality for the entire study population, the absence of harm and the potential benefits in the most frail subgroups suggest that deprescribing can be a valuable tool for harm reduction, reducing polypharmacy and its associated risks.<\/li>\n<li><strong>Further Research:<\/strong> The intriguing finding regarding COVID-19 mortality warrants further investigation to understand if there are any indirect benefits of deprescribing antihypertensives in the context of infectious diseases.<\/li>\n<\/ul>\n<p>In conclusion, the groundbreaking research by Dr. Benetos and his team provides critical, evidence-based insights into the complex management of hypertension in one of the most vulnerable patient populations. It signals a shift towards a more personalized and nuanced approach to medication management in geriatric care, emphasizing the need to move beyond blanket guidelines and consider the individual patient&#8217;s unique circumstances, particularly frailty, when making decisions about antihypertensive therapy.<\/p>\n<!-- RatingBintangAjaib -->","protected":false},"excerpt":{"rendered":"<p>The complex landscape of medication management for older adults, particularly those in nursing home settings, is undergoing a critical re-evaluation, highlighted by a groundbreaking study published in the New England Journal of Medicine. This research, led by Dr. Athanase Benetos, a geriatrician researcher at the University Hospital of Nancy Lorraine and senior researcher at the &hellip;<\/p>\n","protected":false},"author":1,"featured_media":5245,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[90],"tags":[581,215,94,585,580,93,66,92,536,583,582,91,584,315,586],"newstopic":[],"class_list":["post-5246","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-palliative-hospice-care","tag-antihypertensives","tag-challenges","tag-comfort-care","tag-conventional","tag-deprescribing","tag-end-of-life","tag-home","tag-hospice-care","tag-landmark","tag-nursing","tag-older","tag-palliative-care","tag-residents","tag-study","tag-wisdom"],"_links":{"self":[{"href":"https:\/\/homecares.net\/index.php?rest_route=\/wp\/v2\/posts\/5246","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/homecares.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/homecares.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/homecares.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/homecares.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5246"}],"version-history":[{"count":0,"href":"https:\/\/homecares.net\/index.php?rest_route=\/wp\/v2\/posts\/5246\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/homecares.net\/index.php?rest_route=\/wp\/v2\/media\/5245"}],"wp:attachment":[{"href":"https:\/\/homecares.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5246"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/homecares.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5246"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/homecares.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5246"},{"taxonomy":"newstopic","embeddable":true,"href":"https:\/\/homecares.net\/index.php?rest_route=%2Fwp%2Fv2%2Fnewstopic&post=5246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}