Frail older adults are commonly prescribed blood pressure medication, yet it is unclear if
blood pressure medication is actually beneficial for them. Observational studies in this
population suggest blood pressure medication has limited benefit and may even be harmful,
including an increased risk for falls and cognitive impairment. Randomized controlled trials
are needed to confirm this.
This study is a randomized controlled trial of blood pressure medication deprescribing,
amongst long-term care residents with systolic blood pressure lower than 135 mmHg. In the
intervention group, with physician consent, the facility pharmacist will reduce blood
pressure medication until the blood pressure reaches the target systolic blood pressure of
140 ±5 mmHg. The control group will receive usual care. The primary outcome is all-cause
mortality but the study will also be tracking all-cause hospitalization or emergency room
visits, hip fractures, cost of medication, and quality of life.
The hypothesis is that avoiding unnecessarily low systolic blood pressure is beneficial in a
frail, end-of-life population.