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Design and Participants: This study emulated a target trial to estimate the effect of antihypertensive deprescribing vs continued use on functional status in Veteran Affairs long-term care residents (≥65 yrs) who had a stay of 12 weeks or more between 2006 and 2019. After 4 or more weeks of stable antihypertensive use, residents were classified as deprescribed (reduced ≥1 medication or ≥30% dose) or continued users. Residents were followed for 2 years or censored at discharge, admission to hospice, protocol deviation (per-protocol analysis only), or September 30, 2019. The outcome was activities of daily living (ADL) dependencies (scored 0-28; higher=worse), assessed approximately every 3 months. The primary approach was to estimate per-protocol effects using linear mixed-effects regressions with inverse probability of treatment and censoring weighting, overall and stratified by dementia status. Secondary analysis estimated intention-to-treat effects.
Results: Participants (N=12,238) were aged a mean of 78 years (SD=8); were 2.6% female; and were 73% White, 19% Black, 1.4% Asian, less than 1% American Indian, and 6.1% Hispanic. Scores worsened by a mean of 0.29 points (95% CI=0.27-0.31) per 3 months, and deprescribing did not impact this worsening (between-group difference −0.04 points every 3 months [−0.15-0.06]). In the nondementia subgroup, ADL worsened 0.15 points (0.11-0.19) every 3 months. However, residents who were deprescribed showed a slightly improved score over time while the continued users showed ADL decline (between-group difference −0.23 points every 3 months [−0.43 to −0.03]). Deprescribing was not associated with ADL change in the dementia subgroup. Intention-to-treat results were not different.
Commentary: Throughout clinical training, clinicians are taught to diagnose and treat patients’ medical conditions primarily by prescribing medication but receive limited training on deprescribing. This study’s strengths are its large sample size, unique and practical patient population (older adults in long-term care facilities, who are often excluded from studies), and its relatively long follow-up period. The study confirmed that deprescribing antihypertensives did not negatively impact ADLs among these older adults, including patients with dementia. Accumulating evidence supporting safe deprescribing provides reassurance not only to clinicians but also to patients and their families. The study stopped enrollment at 16 weeks to reduce the likelihood of end-of-life (EOL) deprescribing, however, further studies would be required to assess whether deprescribing could contribute to ADL trajectories at EOL.
Bottom Line: Deprescribing antihypertensives among nursing home residents does not negatively impact ADLs.
Reviewer: Ayano Kiyota, MD PhD FAAFP FAAHPM, University of Michigan Medical School, Ann Arbor, MI
References:
- Song W, Intrator O, Lee S, Boockvar K. Antihypertensive drug deintensification and recurrent falls in long-term care. Health Serv Res. 2018;53(6):4066-4086. doi:10.1111/1475-6773.13074.
- Sheppard JP, Benetos A, Bogaerts J, Gnjidic D, McManus RJ. Strategies for identifying patients for deprescribing of blood pressure medications in routine practice: an evidence review. Curr Hypertens Rep. 2024;26(5):225-236. doi:10.1007/s11906-024-01293-5.
Source: Liu X, Graham LA, Jing B, et al. Antihypertensive deprescribing and functional status in VA long-term care residents with and without dementia. J Am Geriatr Soc. 2025;73(4):1144-1154. doi:10.1111/jgs.19342.
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