Abstract :

Polypharmacy with antihypertensive agents in frail older adults presents a clinical dilemma: continuing therapy may preserve cardiovascular protection, yet it simultaneously increases the risk of orthostatic hypotension, falls, and drug-related adverse events. This narrative review synthesizes contemporary clinical evidence on the safety and efficacy of antihypertensive deprescribing (gradual withdrawal or dose reduction) in frail geriatric populations, particularly those residing in long-term care facilities. Literature searches were conducted in PubMed/MEDLINE, Cochrane Library, and Google Scholar (2011–2025).

Key findings include: the OPTIMISE randomized trial, which demonstrated that withdrawing one antihypertensive agent in patients aged ≥80 years was non-inferior to usual care for systolic blood pressure control over 12 weeks, with 66% sustaining the reduction. The DANTE trial found no cognitive benefit from discontinuation in older adults with mild cognitive impairment. Observational data from the PARTAGE study revealed that low systolic blood pressure combined with ≥2 antihypertensives was associated with increased two-year mortality in frail nursing home residents, supporting the rationale for deprescribing in this subgroup. A Cochrane systematic review (2020, updated 2023) encompassing six trials (1,073 participants) found no significant association between antihypertensive withdrawal and mortality, myocardial infarction, stroke, or hospitalization, though evidence on falls and quality of life remains limited.

Overall, current evidence supports selective, closely monitored deprescribing in frail geriatric patients. However, long-term outcomes and data specific to Asian populations, including Indonesia, remain scarce, underscoring the need for further research.

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Keywords :

antihypertensives, deprescribing, frailty, geriatrics, orthostatic hypotension, polypharmacy.

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References :

1. Sheppard JP, Burt J, Lown M, Temple E, Lowe R, Fraser R, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. JAMA. 2020;323(20):2039-2051. doi:10.1001/jama.2020.4871.
2. Sheppard JP, Payne RA. Deprescribing antihypertensives in patients with multimorbidity. Prescriber. 2020;31(9):16-19. doi:10.1002/psb.1870.
3. US Deprescribing Research Network. The OPTIMISE Randomized Clinical Trial: Deprescribing Antihypertensive Medications in Adults Aged 80 and Older and its Effect on Blood Pressure [ringkasan penelitian]. 2021.
4. Sheppard, J. P., Temple, E., Wang, A., Smith, A., Pollock, S., Ford, G. A., Hobbs, F. D. R., Kenealy, N., Little, P., Lown, M., de Lusignan, S., Mant, J., McCartney, D., Payne, R. A., Williams, M., Yu, L.-M., & McManus, R. J. Effect of antihypertensive deprescribing on hospitalisation and mortality: long-term follow-up of the OPTiMISE randomised controlled trial. Lancet Healthy Longev. 2024.
5. Moonen JE, Foster-Dingley JC, de Ruijter W, van der Grond J, de Craen AJ, van der Mast RC. Effect of discontinuation of antihypertensive treatment in elderly people on cognitive functioning: the DANTE Study Leiden  a randomized clinical trial. JAMA Intern Med. 2015;175(10):1622-1630.
6. Benetos A, Labat C, Rossignol P, Fay R, Rolland Y, Valbusa F, et al. Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study. JAMA Intern Med. 2015;175(6):989-995. doi:10.1001/jamainternmed.2014.8012.
7. Valbusa F, Labat C, Salvi P, Vivian ME, Hanon O, Benetos A, et al. Orthostatic hypotension in very old individuals living in nursing homes: the PARTAGE study. J Hypertens. 2012;30(1):53-60.
8. Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, et al. Withdrawal of antihypertensive drugs in older people. Cochrane Database Syst Rev. 2020;6:CD012572. Diperbarui 2023.
9. Kementerian Kesehatan RI. (2019). Laporan Nasional Riskesdas 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan. https://www.litbang.kemkes.go.id/laporan-riset-kesehatan-dasar-riskesdas/
10. Dinas Kesehatan Provinsi Jawa Barat. (2024). Profil Kesehatan Provinsi Jawa Barat Tahun 2023. Bandung: Dinkes Provinsi Jawa Barat.
11. Dinas Kesehatan Kabupaten Majalengka. (2024). Profil Kesehatan Kabupaten Majalengka Tahun 2023. Majalengka: Dinkes Kabupaten Majalengka.