Trial reportHypertension (Dallas, Tex. : 1979)2022
Cost-Effectiveness of Antihypertensive Deprescribing in Primary Care: a Markov Modelling Study Using Data From the OPTiMISE Trial.
Trial report in Hypertension (Dallas, Tex. : 1979), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- Deprescribing Interventions in Older Adults with Polypharmacy: A Systematic Review of Economic Evaluations.Applied health economics and health policy · 2026Pooled it
- Effective deprescribing strategies for reducing potentially inappropriate medications and improving economic outcomes in community-based settings: a systematic review and meta-analysis.BMC health services research · 2026Pooled it
- Economic Evaluations of Medication Safety Interventions in Primary and Long-Term Care: A Systematic Review.PharmacoEconomics · 2026Pooled it
- Withdrawal of antihypertensive drugs in older people.The Cochrane database of systematic reviews · 2025Pooled it
- Article
- Antihypertensive Deprescribing and Functional Status in VA Long-Term Care Residents With and Without Dementia.Journal of the American Geriatrics Society · 2025Article
- Deprescribing Hypertension Medication in Older Adults: Can It Lower Drug Burden Without Causing Harm?Clinics in geriatric medicine · 2024Review
- Challenging the status quo: deprescribing antihypertensive medication in older adults in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
- How to navigate drug shortages with patients in primary care: Beneficial opportunities may exist beyond initial frustrations.Canadian family physician Medecin de famille canadien · 2024Article
- We have the technology: Why aren't better blood pressure data available from nursing home residents?Journal of the American Geriatrics Society · 2023Article
- Value assessment of deprescribing interventions: Suggestions for improvement.Journal of the American Geriatrics Society · 2023Article
- The therapeutic concordance approach reduces adverse drug reactions in patients with resistant hypertension.Frontiers in cardiovascular medicine · 2023Article
- Antihypertensive Deprescribing in Older Adults: a Practical Guide.Current hypertension reports · 2022Review
- D.I.Ri.M.O. project: deprescription, inappropriateness evaluation and therapeutic reconciliation in hospital medicine.Global & regional health technology assessmentArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundDeprescribing of antihypertensive medications for older patients with normal blood pressure is recommended by some clinical guidelines, where the potential harms of treatment may outweigh the benefits. This study aimed to assess the cost-effectiveness of this approach.
methodsA Markov patient-level simulation was undertaken to model the effect of withdrawing one antihypertensive compared with usual care, over a life-time horizon. Model population characteristics were estimated using data from the OPTiMISE antihypertensive deprescribing trial, and the effects of blood pressure changes on outcomes were derived from the literature. Health-related quality of life was modeled in Quality-Adjusted Life Years (QALYs) and presented as costs per QALY gained.
resultsIn the base-case analysis, medication reduction resulted in lower costs than usual care (mean difference £185), but also lower QALYs (mean difference 0.062) per patient over a life-time horizon. Usual care was cost-effective at £2975 per QALY gained (more costly, but more effective). Medication reduction resulted more heart failure and stroke/TIA events but fewer adverse events. Medication reduction may be the preferred strategy at a willingness-to-pay of £20 000/QALY, where the baseline absolute risk of serious drug-related adverse events was ≥7.7% a year (compared with 1.7% in the base-case).
conclusionsAlthough there was uncertainty around many of the assumptions underpinning this model, these findings suggest that antihypertensive medication reduction should not be attempted in many older patients with controlled systolic blood pressure. For populations at high risk of adverse effects, deprescribing may be beneficial, but a targeted approach would be required in routine practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.