Antihypertensive deprescribing in Long-Term Care

• Author / Creator

  Kraut, Roni

• Antihypertensives are prevalent in long-term care (LTC) populations, however the ratio of benefit to harm of antihypertensive treatment is unclear. There has not yet been a randomized controlled trial to examine the impact of deprescribing all classes of antihypertensive medication in the frail older adult population with a primary outcome of mortality. This thesis is focused on designing a study protocol to address this. This thesis has two parts: (1) a scoping review of cluster randomized trials in LTC and (2) a protocol for a randomized controlled antihypertensive deprescribing trial in LTC.
  Study 1. The scoping review was done to help plan the randomized controlled trial. It followed PRISMA guidelines. Studies were included if the design was cluster randomized and residents were from LTC facilities. 195 studies met the inclusion criteria; they were published between 1976 and 2017, with 53% of studies published after 2009. Six percent of studies (n=14) had an Intervention target related to medications, and none of these were on antihypertensive medication. In addition the majority of studies did obtain consent from residents and/or their proxy.
  Study 2. The protocol is for a randomized, two parallel group, open-label, event driven trial. It will include 515 LTC residents with a diagnosis of hypertension, on ≥ one antihypertensive medication, and a systolic blood pressure ≤135 mmHg, and follow them for 3 years. The data steward, Alberta Health Services’ Research Data Services, will identify and randomize residents, and analyze the results. The facility pharmacist will deprescribe antihypertensives in the intervention group using the algorithm developed by the study authors. The primary outcome is time to all-cause mortality, and secondary outcomes include safety, qualify of life and process measures.
  In conclusion, the study designed will help provide clarity to the question of antihypertensive deprescribing in LTC. It is anticipated the results will guide practitioners, and be used in setting hypertension guidelines for the frail older adult population.

• Subjects / Keywords

  • Antihypertensives
  • Deprescribing
  • Long-Term Care

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-kj42-c083

• License

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