Desprescrição de anti-hipertensivos em idosos com hipotensão na atenção primária: análise de subgrupo do ensaio clinico randomizado MINOR

Abstract

Hypertension is a prevalent chronic condition among the older people and when uncontrolled, it can lead to overdiagnosis, overtreatment, and clinical complications, including hypotension. This study aims to evaluate pharmacist-guided deprescription of antihypertensive medications along with home blood pressure monitoring in older patients exhibiting signs and symptoms of hypotension. This analysis is part of the MINOR clinical trial, a randomized, open-label, parallel-group study conducted from June 2021 to August 2022 in a public pharmacy in northeastern Brazil with hypertensive elderly patients. Both groups received a blood pressure monitor and instructions for home monitoring. In the control group, a physician adjusted treatment based on reported blood pressure values. In the intervention group, a pharmacist provided the physician with a report including blood pressure values and suggestions to optimize antihypertensive therapy. Results were analyzed using SPSS Statistics version 27.0, employing the Kolmogorov-Smirnov test for variable normality, the T-test and Levene's test for differences in mean blood pressure and antihypertensive use before and after intervention, and Pearson's χ² test for differences in the proportion of pharmaceutical suggestions between groups. A 95% confidence interval was adopted, with differences considered significant at P < 0.05. RESULTS: A total of 72 patients were evaluated (35 randomized to the control group and 37 to the intervention group). The intervention group showed a significant reduction in medications (-28.6%), particularly beta-blockers (-74.2%), loop diuretics (-83.3%), and aldosterone antagonists (-80%). The mean blood pressure in the intervention group increased more (14.2 mmHg systolic and 7.5 mmHg diastolic) but remained within the target range (140 x 90 mmHg). There was a more significant reduction in hypotension symptoms in the intervention group (64.9%) compared to the control (20%), with p<0.0001, highlighting the effective role of the pharmacist in clinical care management through careful medication deprescription. Deprescribing antihypertensives in the elderly can be a useful tool in blood pressure control and reducing hypotensive symptoms.