Heart Medication Deprescribing

What Is Heart Medication Deprescribing?

A July update from the American Heart Association highlights deprescribing as part of cardiovascular care when multiple prescriptions, side effects, difficulty following treatment or changing goals warrant reassessment. The central question is whether each medicine still serves a useful purpose for the individual taking it. Several medications may remain necessary because they treat different conditions or provide complementary protection. Decisions should involve the patient and clinical team, with careful tapering where needed and follow-up after changes. [American Heart Association overview](https://professional.heart.org/en/science-news/deprescribing-in-patients-with-cardiovascular-disease-experiencing-polypharmacy).

Reviews become particularly useful when someone develops dizziness, fainting or another possible medication-related problem. Clinicians check the reason for each prescription, overlapping treatments and interactions, including those involving nonprescription products. They also look for a prescribing cascade: a drug causes a symptom that is mistaken for a new illness, prompting another prescription. A cardiovascular deprescribing review in the Journal of the American College of Cardiology describes this problem and recommends evaluating medicines against the patient's current clinical circumstances and priorities. [Cardiovascular deprescribing review](https://pmc.ncbi.nlm.nih.gov/articles/PMC6724706/).

Can Older Adults Safely Reduce Blood Pressure Medication?

The OPTIMISE randomized trial, published in JAMA in 2020, enrolled 569 adults aged 80 or older whose systolic blood pressure was below 150 mm Hg while taking at least two antihypertensive medicines. Their primary care physicians considered them suitable for medication reduction. At 12 weeks, blood pressure remained below that threshold in 86.4% of participants assigned to remove one medicine and 87.7% receiving usual care. The reduction strategy met the trial's prespecified noninferiority criterion, although average systolic pressure was modestly higher after medication reduction. The 150 mm Hg threshold was a study outcome, not a universal treatment target. [OPTIMISE trial](https://jamanetwork.com/journals/jama/fullarticle/2766421).

Extended follow-up published in The Lancet Healthy Longevity in 2024 tracked 564 participants for a median of four years. Researchers found no evidence of an increase in the combined outcome of hospitalization or death among those originally assigned to medication reduction. However, the uncertainty around the estimate allowed for possible benefit or harm, and treatment could change during follow-up. These results support considering a monitored reduction in appropriately selected patients; they do not establish that stopping blood-pressure medicines is safe for all older adults or that deprescribing improves survival. [Long-term OPTIMISE findings](https://pubmed.ncbi.nlm.nih.gov/39094592/).

Why Can Stopping Heart Medication Be Dangerous?

The TRED-HF trial illustrates the danger of assuming recovery means treatment is unnecessary. Published in The Lancet in 2019, this small randomized study examined people with previously dilated, weakened hearts whose symptoms and cardiac measurements had improved. During the first six months, 11 of 25 participants assigned to phased withdrawal of heart-failure medicines met the study's relapse criteria, compared with none of 26 assigned to continue treatment. Relapse included deterioration detected by cardiac testing, rather than necessarily a hospital admission. The findings suggest that apparent recovery can represent remission maintained by treatment. [TRED-HF trial](https://pmc.ncbi.nlm.nih.gov/articles/PMC6319251/).

A practical deprescribing plan therefore identifies the medicine being changed, the reason, any tapering instructions and how deterioration will be detected. Monitoring may include symptoms, blood pressure, pulse or laboratory tests, depending on the drug and condition. The plan should also specify when to contact the clinical team and when treatment might need to resume. Abrupt beta-blocker withdrawal can cause a rapid increase in heart rate and potentially provoke chest pain, making unsupervised changes particularly concerning. [Deprescribing framework](https://pmc.ncbi.nlm.nih.gov/articles/PMC6724706/), [Harvard Health medication review](https://www.health.harvard.edu/heart-health/time-for-a-medication-check-up).