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The trial is funded by the National Institute for Health Research, Oxford Collaboration for Leadership in Applied Health Research and School for Primary Care Research. Ethics Ref: 16/SC/0628. EudraCT Number: 2016-004236-38.

background

High blood pressure increases the risk of heart attack and stroke and is the most common chronic condition in older patients. More than half of patients aged 80 years or older will have high blood pressure, many of which may be taking two or more different drugs to control it.

Although reducing blood pressure with medications can be beneficial, in older individuals large reductions in blood pressure have been linked to an increased risk of falls which can lead to death. Taking multiple medications (polypharmacy) can also lead to the prescription of even more drugs. Reducing the number of high blood pressure drugs a patient takes may reduce both the increased risk of falls and death of elderly patients and polypharmacy.

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Objectives

  • To assess the safety of reducing medication in older patients with controlled systolic blood pressure.
  • Reducing the number of antihypertensive drugs prescribed to certain older patients may be beneficial by improving quality of life and reducing the risk of falls.
  • To see if reducing the number of blood pressure lowering medications can improve the quality of life of individuals entering older age.

Trial Design

Patients over 80 years old with well-controlled blood pressure and who take two or more blood pressure lowering drugs will be invited to take part in OPTiMISE. Patients will be randomly assigned to either the medication reduction (intervention) or usual care (control) groups. The medication reduction group will have one blood pressure lowering medication removed by their GP. They will then be shown how to measure their own blood pressure at home and asked to report to their GP immediately if levels rise too high in the following weeks. Those not willing to self-monitor will be asked to return to their GP for an additional safety visit after one month of medication reduction. All patients will be asked to attend one follow-up visit at 12 weeks. All visits will take place at the patients GP practice.

Importance

Reducing the number of drugs taken by elderly patients should make managing and complying with more complex medication schedules easier for patients and carers. It could also result in fewer serious falls and their associated complications, such as broken bones and hospitalisation. This would have the combined effect of improving and prolonging quality of life for elderly patients, as well as freeing up NHS resources. If this research shows blood pressure medication reduction to be effective, it could have a significant impact on future clinical guidelines and patient care. Over 1.2 million older patients throughout the UK are thought to be potentially eligible blood pressure lowering medication reduction right now. This number is expected to rise over the next 30 years as more and more people live beyond 80 years of age

 

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