ArticleJournal of the American Geriatrics Society2021
Clinical outcomes of modifying hypertension treatment intensity in older adults treated to low blood pressure.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Deprescribing antihypertensive medications in older people: a systematic review and a meta-analysis.BMC geriatrics · 2026Pooled it
- Effect of antihypertensive deprescribing on hospitalisation and mortality: long-term follow-up of the OPTiMISE randomised controlled trial.The lancet. Healthy longevity · 2024Trial
- Mechanistic Pathways Linking Type 2 Diabetes Mellitus, Hypertension, and Osteoarthritis to Falls in Older Adults: A Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- Efficacy and safety of antihypertensive drugs deprescribing in older adults: A systematic review and meta-analysis of randomized controlled trials.International journal of cardiology. Cardiovascular risk and prevention · 2026Review
- Complex Patterns of Antihypertensive Treatment Changes in Long-Term Care Residents.Journal of the American Medical Directors Association · 2024Article
- Risk factors of undiagnosed and uncontrolled hypertension in primary care patients with hypertension: a cross-sectional study.BMC primary care · 2024Article
- Survival benefit and impact of adjuvant therapies following FOLFOX-HAIC-based conversion therapy with unresectable hepatocellular carcinoma: a retrospective cohort study.Journal of cancer research and clinical oncology · 2023Article
- Systemic therapy with or without transcatheter intra-arterial therapies for unresectable hepatocellular carcinoma: a real-world, multi-center study.Frontiers in immunology · 2023Article
- Antihypertensive Deprescribing in Older Adults: a Practical Guide.Current hypertension reports · 2022Review
- Clinical outcomes of modifying hypertension treatment intensity in older adults treated to low blood pressure.Journal of the American Geriatrics Society · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
BACKGROUND/
objectivesHypertension treatment reduces cardiovascular events. However, uncertainty remains about benefits and harms of deintensification or further intensification of antihypertensive medication when systolic blood pressure (SBP) is tightly controlled in older multimorbid patients, because of their frequent exclusion in trials. We assessed the association of hypertension treatment deintensification or intensification with clinical outcomes in older adults with tightly controlled SBP.
designLongitudinal cohort study (2011-2013) with 9-month follow-up.
settingU.S.-nationwide primary care Veterans Health Administration healthcare system.
participantsVeterans aged 65 and older with baseline SBP <130 mmHg and ≥1 antihypertensive medication during ≥2 consecutive visits (N = 228,753). EXPOSURE: Deintensification or intensification, compared with stable treatment. MAIN OUTCOMES AND MEASURES: Cardiovascular events, syncope, or fall injury, as composite and distinct outcomes, within 9 months after exposure. Adjusted logistic regression and inverse probability of treatment weighting (IPTW, sensitivity analysis).
resultsAmong 228,753 patients (mean age 75 [SD 7.5] years), the composite outcome occurred in 11,982/93,793 (12.8%) patients with stable treatment, 14,768/72,672 (20.3%) with deintensification, and 11,821/62,288 (19.0%) with intensification. Adjusted absolute outcome risk (95% confidence interval) was higher for deintensification (18.3% [18.1%-18.6%]) and intensification (18.7% [18.4%-19.0%]), compared with stable treatment (14.8% [14.6%-15.0%]), p < 0.001 for both effects in the multivariable model). Deintensification was associated with fewer cardiovascular events than intensification. At baseline SBP <95 mmHg, cardiovascular event risk was similar for deintensification and stable treatment, and fall risk lower for deintensification than intensification. IPTW yielded similar results. Mean follow-up SBP was 124.1 mmHg for stable treatment, 125.1 mmHg after deintensification (p < 0.001), and 124.0 mmHg after intensification (p < 0.001).
conclusionAntihypertensive treatment deintensification in older patients with tightly controlled SBP was associated with worse outcomes than continuing same treatment intensity. Given higher mortality among patients with treatment modification, confounding by indication may not have been fully corrected by advanced statistical methods for observational data analysis.
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