Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
BMC Prim Care. 2022 Nov 9;23(1):280. doi: 10.1186/s12875-022-01894-6.
Older patients using antihypertensive medication may experience Adverse Drug Events (ADEs), and thus benefit from deprescribing. The lack of a practical protocol may hamper deprescribing. Therefore, we aimed to develop a deprescribing protocol, based on a review of literature, combined with a feasibility test in a small number of patients.
A deprescribing protocol for general practitioners was drafted and tested in older patients using multiple antihypertensive medication in a single arm intervention. Patients were included if they were 75 years or older, were using two or more antihypertensives, had at least one ADE linked to antihypertensive medication and deprescribing was considered to be safe by their general practitioner. The primary outcome was the percentage of patients for whom one or more antihypertensive drugs were stopped or reduced in dose after 12 months of follow up while maintaining safe blood pressures. Secondary outcomes were the proportion of patients reporting no ADEs after 12 months and the number of deprescribed antihypertensives. Patient's opinions on deprescribing and enablers and barriers for study participation were also collected.
Nine general practitioners included 14 patients to deprescribe antihypertensive medication using the deprescribing protocol. After 12 months antihypertensive drug use was lowered in 11 patients (79%). These patients had a mean systolic blood pressure increase of 16 mmHg and a mean diastolic blood pressure increase of 8 mmHg. Nine patients (64%) reported experiencing no ADEs anymore after twelve months. The mean number of deprescribed antihypertensives was 1.1 in all patients and 1.4 (range: 0.5 to 3.5) in patients who successfully lowered their medication. At baseline, being able to use less medication was the most frequently mentioned enabler to participate in this study. The most frequently mentioned positive experience at the end of the study was using less medication, which was in line with the most mentioned enabler to participate in this study.
A protocol for deprescribing antihypertensives in older patients was considered feasible, as it resulted in a substantial degree of safe deprescribing in this pilot study. Larger studies are needed to demonstrate the effect and safety of deprescribing antihypertensives in older patients.
使用降压药物的老年患者可能会经历药物不良反应（ADEs），因此可以从减少用药中获益。缺乏实用的方案可能会阻碍减少用药。因此，我们旨在制定一个基于文献综述的减少用药方案，并在少数患者中进行可行性测试。
在一项单臂干预研究中，为全科医生起草并测试了一个针对使用多种降压药物的老年患者的减少用药方案。如果患者年龄在 75 岁或以上，使用两种或以上的降压药物，至少有一种与降压药物相关的 ADE，并且他们的全科医生认为减少用药是安全的，则可以纳入研究。主要结局是在 12 个月的随访期间，维持安全血压的情况下，停止或减少一种或多种降压药物的患者比例。次要结局是在 12 个月后报告没有 ADE 的患者比例和减少用药的降压药物数量。还收集了患者对减少用药的意见以及研究参与的促进因素和障碍。
9 名全科医生纳入了 14 名患者，使用减少用药方案减少降压药物的使用。在 12 个月时，11 名患者（79%）降低了降压药物的使用。这些患者的收缩压平均增加了 16mmHg，舒张压平均增加了 8mmHg。9 名患者（64%）报告在 12 个月后不再出现 ADE。所有患者平均减少了 1.1 种降压药物，成功降低药物的患者减少了 1.4 种（范围：0.5 至 3.5）。在基线时，能够减少用药是参与本研究的最常被提及的促进因素。在研究结束时，最常被提及的积极体验是使用较少的药物，这与参与本研究的最常被提及的促进因素一致。
在本试点研究中，减少老年患者降压药物的方案被认为是可行的，因为它导致了相当程度的安全减少用药。需要更大规模的研究来证明减少老年患者降压药物的效果和安全性。
