Planned Antihypertensive Deprescribing in Long-Term Care Residents: A Systematic Review of Randomized Evidence

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• Picked for Internal Medicine (top studies of the week, 18 October 2026): Systematic review of antihypertensive deprescribing in frail elders

Abstract

BACKGROUND: Evidence supporting antihypertensive treatment in older adults is derived largely from populations that differ from long-term care residents, in whom frailty, dementia, multimorbidity, polypharmacy, and competing clinical priorities may alter the balance between preventive benefit and treatment burden. OBJECTIVES: The aim was to synthesize randomized evidence on planned antihypertensive deprescribing in institutional long-term care and determine whether clinically and methodologically comparable effects support a common treatment-effect estimate. METHODS: Randomized or cluster-randomized studies of planned antihypertensive deprescribing in long-term care were systematically reviewed. MEDLINE/PubMed, Embase, CENTRAL, CINAHL Complete, Web of Science Core Collection, trial registries, and PROSPERO were searched from inception and updated to 20 August 2026. Meta-analysis was reserved for outcomes with at least two clinically and methodologically compatible estimates of a common, interpretable effect; otherwise, structured study-level synthesis was used. Result-specific risk of bias was assessed with the revised Cochrane risk-of-bias tool (RoB 2), and certainty with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Three randomized long-term care studies involving 1548 residents were included. Their populations, deprescribing strategies, monitoring, restart criteria, and follow-up differed substantially, and no outcome was considered sufficiently clinically and methodologically comparable for meta-analysis. RETREAT-FRAIL reported an adjusted hazard ratio (HR) for all-cause mortality of 1.02 (95% confidence interval 0.86-1.21) over a median potential follow-up of 38.4 months, whereas DANTON reported an HR of 1.65 (0.95-2.85) to 32 weeks; Gulla/COSMOS had no cluster-adjusted comparative mortality estimate. At 16 weeks in DANTON, deprescribing increased systolic blood pressure by 11.0 mmHg (5.6-16.4), increased diastolic blood pressure by 4.6 mmHg (1.1-8.1), and reduced the number of antihypertensive drugs by 1.2 (1.0-1.4). Evidence for hospitalization, falls, cardiovascular events, cognition, function, and quality of life remained sparse, outcome-specific, or at risk of bias. CONCLUSIONS: Randomized evidence for antihypertensive deprescribing in long-term care remains sparse and clinically heterogeneous. Within individual trials, supervised deprescribing reduced antihypertensive exposure and raised blood pressure, but the magnitude and clinical consequences varied by strategy and follow-up. Current evidence does not establish a common effect on mortality, hospitalization, or other resident-important outcomes, making trial-specific estimates and deprescribing protocols more informative than a single pooled treatment effect. PROSPERO REGISTRATION: CRD420261370802.

Abstract as published, via PubMed.