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Invited Commentary
October 2015

A Discontinuation Trial of Antihypertensive TreatmentThe Other Side of the Story

Author Affiliations
  • 1School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2015;175(10):1630-1632. doi:10.1001/jamainternmed.2015.4309

The overwhelming majority of research and guidelines has focused on the initiation and intensification of medication therapy. Not surprisingly, the burden of medication use in older adults is high; nearly 40% of adults 65 years or older and 50% of those 80 years or older are using 5 or more prescription medications.1 The use of cardioprotective medications, including antihypertensives and statins, is greatest among those 80 years or older.1 At present, no US guidelines are available for the discontinuation of blood pressure–lowering medications, although the 2014 guideline from the panel members appointed to the Eighth Joint National Committee2 recommends a higher systolic blood pressure treatment target among adults 60 years or older. Presumably, this target would result in the discontinuation of antihypertensive treatments in some older adults, but the consequences of this discontinuation and whether those 60 years or older constitute the right population have been controversial.3 A group from Canada4 recently released a guideline for frail older adults that recommended a target systolic blood pressure of 140 to 160 mm Hg and of 160 to 190 mm Hg in those with limited life expectancy; however, the investigators also note that the guideline was based on consensus expert opinion owing to the limited available evidence in these populations.