Effect of antihypertensive medication reduction on short-term blood pressure control in older adults: calibration of OPTiMISE trial results to real-world primary care data.
Background While antihypertensive treatment prevents cardiovascular events, it may also increase risks such as falls in patients with frailty. The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTiMISE) trial found that deprescribing one antihypertensive drug did not result in...
| Publicado en: | Age & Ageing Vol. 55; no. 6; pp. 1 - 10 |
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| Autores principales: | , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Jun2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195099740&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195099740 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2026 vid: 55 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195099740 10.1093/ageing/afag192 ppf: 1 ppct: 9 formats: tig: atl: Effect of antihypertensive medication reduction on short-term blood pressure control in older adults: calibration of OPTiMISE trial results to real-world primary care data. aug: au: Christiaens, Antoine Wang, Ariel McAllister, David A McManus, Richard J Sheppard, James P affil: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKLouvain Drug Research Institute/Clinical Pharmacy and Pharmacoepidemiology Research Group, Université catholique de Louvain, Brussels, Belgium Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK School of Health and Wellbeing, University of Glasgow, Glasgow, UK Brighton and Sussex Medical School, University of Sussex, Brighton, UK su: England Primary health care Hypertension Hospital care Old age Research funding Secondary analysis Antihypertensive agents Deprescribing Treatment effectiveness Descriptive statistics Data analysis software Confidence intervals Calibration Proportional hazards models Regression analysis Evaluation sug: subj: Primary health care Hypertension Hospital care Old age England Pharmaceutical and medicine manufacturing Research funding Secondary analysis Antihypertensive agents Deprescribing Treatment effectiveness Descriptive statistics Data analysis software Confidence intervals Calibration Proportional hazards models Regression analysis Evaluation keyword: antihypertensive treatment calibration copyrightHolder:British Geriatrics Society copyrightYear:2026 deprescribing https://dx.doi.org/10.1093/ageing/afag192 inLanguage:en older adults publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42381392/ statistical transportability antihypertensive treatment calibration copyrightHolder:British Geriatrics Society copyrightYear:2026 deprescribing https://dx.doi.org/10.1093/ageing/afag192 inLanguage:en older adults publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42381392/ statistical transportability ab: Background While antihypertensive treatment prevents cardiovascular events, it may also increase risks such as falls in patients with frailty. The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTiMISE) trial found that deprescribing one antihypertensive drug did not result in worse short-term blood pressure control and long-term follow-up showed no observed harm, but its generalisability to routine clinical practice remains uncertain. Objective This study aimed to calibrate the OPTiMISE effect to a representative primary care population in England. Methods We calibrated the OPTiMISE treatment effect using inverse probability weighting (IPW) based on trial inclusion likelihood. The trial enrolled 569 adults aged ≥80 years with controlled blood pressure on ≥2 antihypertensive drugs. A target population was reconstructed from electronic health records of 24 participating practices and extrapolated to all English adults aged ≥80 years, prescribed ≥2 antihypertensive drugs, using NHS Digital data. The primary outcome was all-cause hospitalisation or death. Weighted Cox models estimated calibrated hazard ratios (HRs). Results The target population included 798 179 individuals (median age 84 years [81–87], 48% female). Compared with OPTiMISE participants, a higher proportion of individuals in target population were overtly frail (25% vs. 11%). After calibration using IPW, deprescribing was not associated with higher risk of hospitalisation or death [calibrated HR 0.94 (95% CI: 0.73–1.22)], similar to the long-term follow-up of OPTiMISE [HR 0.93 (95% CI: 0.76–1.12)], although with a slightly wider confidence interval. Conclusions Calibrating OPTiMISE findings to a representative primary care population frailer than the original participants suggests that the original trial findings could be translated into a real-world population. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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