Singapore medical journal · 2026
Deprescribing antihypertensives in primary care: clinical and safety outcomes among older adults.
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Yeo Jia Qi, Chia Hui Shan, Tan Dihao Keith
Аннотация
INTRODUCTION: Deprescribing antihypertensives is recommended when the treatment risks outweigh benefits, but evidence on the long-term outcomes in real-world multimorbidity populations remains limited. This study examined the clinical effects of deprescribing antihypertensives on blood pressure (BP) control and safety outcomes at 3 and 12 months of follow-up.
METHODS: From January 2021 to December 2022, we conducted a retrospective review of 108 polyclinic patients aged ≥60 years who had antihypertensives deprescribed. The primary outcome was the proportion of patients who remained within individualised BP targets. Secondary outcomes were maintenance of deprescribing and changes in absolute BP, number of antihypertensives and pill count. Safety outcomes assessed included giddiness, postural hypotension, falls and hospital admissions.
RESULTS: Among the 108 patients (mean age 77.3 years, 54.6% female, 80.6% Chinese), 93.5% and 69.4% maintained deprescribing at 3 and 12 months, respectively. There was no difference in the proportion who remained within BP targets at 12 months (86.1% vs. 94.4%, P = 0.0636) despite an initial decrease in the proportion at 3 months (74.1% vs. 94.4%, P < 0.0001). Systolic BP increased from a baseline of 124.2 mmHg to 133.9 mmHg at 3 months, stabilising at 133.5 mmHg by 12 months. The proportion with postural hypotension decreased ( P = 0.0009), while giddiness ( P = 0.0872) and falls ( P = 0.2100) showed no difference at 12 months. Hospital admissions increased marginally in the study population ( P = 0.0490) but not in the subgroup that maintained deprescribing.
CONCLUSION: There was no difference in BP control at 12 months after deprescribing despite a transient decline at 3 months. This supports the feasibility of deprescribing antihypertensives in older adults in primary care. Further research is needed to evaluate the safety outcomes in larger populations with specific cardiovascular comorbidities.
METHODS: From January 2021 to December 2022, we conducted a retrospective review of 108 polyclinic patients aged ≥60 years who had antihypertensives deprescribed. The primary outcome was the proportion of patients who remained within individualised BP targets. Secondary outcomes were maintenance of deprescribing and changes in absolute BP, number of antihypertensives and pill count. Safety outcomes assessed included giddiness, postural hypotension, falls and hospital admissions.
RESULTS: Among the 108 patients (mean age 77.3 years, 54.6% female, 80.6% Chinese), 93.5% and 69.4% maintained deprescribing at 3 and 12 months, respectively. There was no difference in the proportion who remained within BP targets at 12 months (86.1% vs. 94.4%, P = 0.0636) despite an initial decrease in the proportion at 3 months (74.1% vs. 94.4%, P < 0.0001). Systolic BP increased from a baseline of 124.2 mmHg to 133.9 mmHg at 3 months, stabilising at 133.5 mmHg by 12 months. The proportion with postural hypotension decreased ( P = 0.0009), while giddiness ( P = 0.0872) and falls ( P = 0.2100) showed no difference at 12 months. Hospital admissions increased marginally in the study population ( P = 0.0490) but not in the subgroup that maintained deprescribing.
CONCLUSION: There was no difference in BP control at 12 months after deprescribing despite a transient decline at 3 months. This supports the feasibility of deprescribing antihypertensives in older adults in primary care. Further research is needed to evaluate the safety outcomes in larger populations with specific cardiovascular comorbidities.