Reducing Blood Pressure Medication for High Blood Pressure in Frail Elderly
(OptimizeBP Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial aims to determine if reducing antihypertensive medication is safe and beneficial for frail older adults in long-term care with already low blood pressure. It compares two groups: one with gradually reduced medication and another with continued usual care. The goal is to assess whether less medication can lower risks like falls and memory issues without significantly increasing blood pressure. Eligible participants should have a history of high blood pressure, currently take blood pressure medicine, and have a systolic blood pressure below 135. As an unphased trial, this study provides a unique opportunity to contribute to important research that could enhance care for older adults.
Will I have to stop taking my current medications?
The trial involves reducing blood pressure medication for some participants, but it doesn't specify if you must stop all current medications. If you're in the intervention group, your blood pressure medication may be gradually reduced with your doctor's consent.
What prior data suggests that deprescribing antihypertensive medication is safe for frail elderly patients?
Research shows that reducing or stopping blood pressure medications in frail older adults is often possible and might be safe. Studies suggest that for older people living at home, stopping these medications could be safe if their blood pressure remains stable. However, these medications can increase the risk of falls in frail older adults. Therefore, carefully weighing the benefits and risks is crucial when deciding on these medications for frail individuals.12345
Why are researchers excited about this trial?
Researchers are excited about this trial because it explores a new approach to managing high blood pressure in frail elderly patients by reducing medication, rather than increasing or maintaining it. Unlike standard treatments that typically involve ongoing use of antihypertensive drugs to lower blood pressure, this trial investigates the effectiveness of deprescribing—actively reducing or stopping medication when it's safe. This could potentially minimize medication side effects and improve overall quality of life for elderly patients, making it a promising avenue for personalized, safer care.
What evidence suggests that deprescribing antihypertensive medication is effective for frail elderly with high blood pressure?
This trial will compare two approaches for managing blood pressure in frail elderly patients. In the deprescribing group, the facility pharmacist will actively reduce antihypertensive medication. Research has shown that stopping or reducing blood pressure medication in frail older adults might not increase the risk of heart attacks or strokes. One study found that cutting back on these medications did not lead to more hospital visits for serious heart issues. However, another analysis noted a slight increase in the risk of death after stopping these medications. Observational studies suggest that these drugs may have limited benefits and could even be harmful in older adults, possibly increasing the risk of falls and memory problems. Overall, the evidence is mixed, and more research is needed to understand the benefits and risks. Meanwhile, the usual care group will receive standard care, including quarterly medication reviews.45678
Who Is on the Research Team?
Roni Kraut
Principal Investigator
University of Alberta
Are You a Good Fit for This Trial?
This trial is for long-term care residents who are frail, have high blood pressure, and are on at least one oral antihypertensive medication with an average systolic BP below 135 mmHg. They must have been diagnosed with hypertension at least twice. Those on certain heart medications or with specific heart conditions cannot participate.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Randomization and Intervention
Eligible participants are randomized into either the deprescribing group or the usual care group. In the intervention group, antihypertensive medications are reduced according to a predefined algorithm.
Follow-up
Participants are monitored for safety and effectiveness, including primary and secondary outcomes such as all-cause mortality and hospitalization.
What Are the Treatments Tested in This Trial?
Interventions
- Antihypertensive medication
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Alberta
Lead Sponsor
Alberta Health services
Collaborator