Antihypertensives in care facilities: reducing treatment has no established clinical benefit

Three trials too different for a pooled result

Evidence supporting antihypertensives largely comes from populations unlike long-term care residents. In these residents, frailty, dementia, multiple conditions and the accumulation of medications can change the balance between prevention and treatment burden.

The review brings together three randomized studies, some using cluster randomization. Populations, medication reduction strategies, monitoring, criteria for restarting treatment and follow-up periods differed substantially.

The authors therefore conducted no meta-analysis: no outcome was sufficiently comparable to calculate an interpretable pooled effect. This decision avoids presenting an average that would obscure different clinical situations.

Fewer medications, but higher blood pressure

In the DANTON trial, at 16 weeks, deprescribing reduced the number of antihypertensives by 1.2 compared with the comparator. Systolic blood pressure increased by 11.0 mmHg and diastolic blood pressure by 4.6 mmHg.

These results show a reduced medication burden accompanied by a measurable physiological change. On their own, they do not demonstrate improved quality of life or fewer falls or hospitalizations. For these outcomes, as well as cardiovascular events, cognition and independence, the data remained limited or subject to bias.

Mortality remains an open question

In RETREAT-FRAIL, the hazard ratio for all-cause mortality was 1.02, with a 95% confidence interval of 0.86 to 1.21, over a median potential follow-up of 38.4 months. This estimate shows no clear difference, but does not prove equivalence between the strategies.

In DANTON, this ratio was 1.65, with an interval of 0.95 to 2.85, over up to 32 weeks. The estimate pointed toward higher mortality after deprescribing, but its uncertainty prevented a conclusion. The third trial did not provide a cluster-adjusted comparative mortality estimate.

A medical reassessment, not automatic discontinuation

This review justifies neither routinely reducing antihypertensives in care facilities nor treating all deprescribing as dangerous. Above all, it shows that strategy and monitoring matter, and that one trial’s results do not automatically apply to all residents.

The interventions studied were supervised. These results are not a reason to change your treatment on your own: any reduction should follow a reassessment with the care team.

What we can take away

Supervised deprescribing reduces exposure to antihypertensives and raises blood pressure. No benefit or risk to residents’ mortality or daily life has been established consistently across the trials.