OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE): protocol for a randomised controlled non-inferiority trial

@article{Sheppard2018OPtimisingTF,
  title={OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE): protocol for a randomised controlled non-inferiority trial},
  author={James Peter Sheppard and Jenni Burt and Mark Lown and Eleanor Temple and John M. Benson and Gary A. Ford and Carl J. Heneghan and F. D. Richard Hobbs and Sue Jowett and Paul Little and Jonathan Mant and Jill Mollison and Alecia Nickless and Emma Ogburn and Rupert A. Payne and Marney Williams and Ly-Mee Yu and Richard J. McManus},
  journal={BMJ Open},
  year={2018},
  volume={8}
}
Introduction Recent evidence suggests that larger blood pressure reductions and multiple antihypertensive drugs may be harmful in older people, particularly frail individuals with polypharmacy and multimorbidity. However, there is a lack of evidence to support deprescribing of antihypertensives, which limits the practice of medication reduction in routine clinical care. The aim of this trial is to examine whether antihypertensive medication reduction is possible in older patients without… 

of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial.

This study aimed to establish whether antihypertensive medication reduction is possible without significant changes in systolic blood pressure control or adverse events during 12-week follow-up.

Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial.

The findings suggest antihypertensive medication reduction in some older patients with hypertension is not associated with substantial change in blood pressure control, although further research is needed to understand long-term clinical outcomes.

Blood Pressure Changes Following Antihypertensive Medication Reduction, by Drug Class and Dose Chosen for Withdrawal: Exploratory Analysis of Data From the OPTiMISE Trial

These exploratory data suggest withdrawal of higher dose calcium channel blockers should be avoided if the goal is to maintain BP control, however, low dose beta-blockers may be removed with little impact on blood pressure over 12-weeks of follow-up.

University of Birmingham Generalisability of blood pressure lowering trials to older patients

A possible unintended consequence of blood pressure criteria used by trials attempting to answer different primary questions is that for many older patients, no trial evidence exists to inform treatment decisions in routine practice, and caution should be exercised when applying results from existing trials to patients with frailty or multimorbidity.

Deprescribing Antihypertensive Drugs in Patients of Older Age Groups

An analysis of current literature showed the benefits of deprescribing of antihypertensive drugs for elderly patients with frailty, which avoids potential harm to their health, improves the quality of life and reduces the economic cost of treatment.

Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care

Randomized trials and rigorous observational studies examining effects of deintensified BP management on patient-centered outcomes in complex, older populations are needed to inform improved guidelines and treatment for nursing home (NH) residents.

Cost-Effectiveness of Antihypertensive Deprescribing in Primary Care: a Markov Modelling Study Using Data From the OPTiMISE Trial

Findings suggest that antihypertensive medication reduction should not be attempted in many older patients with controlled systolic blood pressure, and for populations at high risk of adverse effects, deprescribing may be beneficial, but a targeted approach would be required in routine practice.

Blood Pressure Control in Older Adults: Toward a More Personalized Medicine Approach

  • J. Williamson
  • Medicine
    Journal of the American Geriatrics Society
  • 2020
New results show that approximately 34% of adults aged 80 and older in a group of primary care practices in the United Kingdom would be eligible for hypertension guidelines based on the Systolic Blood Pressure Intervention Trial (SPRINT), consistent with those previously published by the SPRINT investigators showing that approximately 36% of older adults would qualify for SPRINT-based guidelines.

Deprescribing antihypertensives in patients with multimorbidity

The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) trial examined the safety and efficacy of antihypertensive deprescribing in older patients taking more than one treatment for hypertension.

Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis

The proportion and characteristics of patients eligible for hypertension trials conducted in older people and how these trials represent the general population attending routine clinical practice are defined are defined.

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