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Table 5 Deprescribing antihypertensive treatment

From: Screening and treatment of hypertension in older adults: less is more?

Definition of deprescribing
Deprescribing can be defined as a systematic process of gradually lessening or stopping drugs with the aim to reduce polypharmacy and improve patient outcomes. This process implies the identification of drugs that are suspected to induce no benefit, or which potentially cause more harm than benefit for the patient. Polypharmacy is common in older adults, and they are especially vulnerable to drug-related adverse events [73]. Deprescribing is therefore particularly relevant in older adults.
Deprescribing antihypertensive treatment in older adults
Some data on antihypertensive treatment withdrawal exist showing that among well-selected older adults [74], a relevant proportion of patients stay normotensive [75, 76], with minor withdrawal-associated risks [77] and potentially beneficial effects on health [78]. Accordingly, a recent Canadian Guideline, specifically addressing BP management in frail older adults, recommends to generally prescribe no more than two antihypertensive medications and to reduce antihypertensive treatment when systolic BP is below 140 mmHg [79]. A recent Cochrane review concluded that the effect of deprescribing was uncertain, with however no increase in mortality among participants allocated to withdrawing from antihypertensive therapy [80].