CATEGORY: HEALTHY AGING & LONGEVITY
Withdrawing blood-pressure pills did not help frail nursing-home residents in their late eighties and nineties live longer. It did not cost them anything either. Over a follow-up of up to four years, 61.7% of those who had some of their pressure medicines gradually taken away died, against 60.2% of those who kept taking them all. The gap sits well within chance. The trial, RETREAT-FRAIL, ran at 108 French nursing homes.1 It takes on a question families and physicians meet constantly and that earlier drug trials, which rarely enrolled the very old and frail, had left hanging.
Two or More Pills a Day, Readings Already Low
The researchers enrolled 1,048 nursing-home residents aged 80 and older, average age about 90, roughly four in five of them women. Every one was taking at least two blood-pressure medications, and every one had a systolic pressure below 130. Systolic is the higher of the two blood-pressure numbers, the reading taken as the heart beats. A random draw, not a physician’s judgment, put each resident into one of two groups. One group had its pressure-lowering drugs wound down step by step under a preset protocol, a supervised process known as deprescribing. The other carried on as before. Because the draw rather than anyone’s preference decided who tapered, the groups started out alike, and any gap at the end belongs to the strategy. Deaths from any cause were the main measure, tracked alongside blood pressure, major cardiovascular events and side effects.
One Pill Fewer, Four Points Higher on the Cuff
The taper worked as designed. The step-down group went from an average of 2.6 pressure medications a day to 1.5, while the usual-care group drifted only from 2.5 to 2.0. The little daily medicine cup that had held two or three pressure pills now typically held one or two. Systolic pressure rose about 4 points higher in the tapered group, a moderate shift. Survival stayed put: 326 deaths in the step-down group (61.7%) against 313 under usual care (60.2%), hazard ratio 1.02, confidence interval 0.86 to 1.21. Major cardiovascular events reached 19.3% of the tapered group versus 17.3% with usual care, with a confidence interval (0.84 to 1.56) wide enough that chance cannot be ruled out in either direction. Side effects came at similar rates on both sides.
The Benefit the Taper Was Built to Deliver
Tolerability was never the target. RETREAT-FRAIL was built to test whether lightening the drug load would actually lower death rates in a very frail population, where pushing pressure low with several drugs has long been suspected of doing more harm than good. That hoped-for benefit never showed. The investigators concluded that the step-down strategy did not produce lower all-cause mortality than usual care, and did produce a moderate rise in blood pressure. The answer is symmetrical. Fewer pills bought no extra survival; the extra pills the usual-care group kept swallowing bought none either. English primary care reached the same place from a different starting point. OPTiMISE, a randomized study of 569 adults aged 80 and older with controlled pressure on two or more drugs, withdrew one medication from half of them. Over a median of four years, 72% of the reduction group versus 77% of the usual-care group died or were hospitalized for any cause, a hazard ratio of 0.93 (confidence interval 0.76 to 1.12), again no statistical difference and no sign of harm.2 Neither trial speaks to younger adults, or to anyone with high, untreated blood pressure, where lowering it has repeatedly been shown to prevent strokes and heart attacks.
Key Takeaways
- Tapering cut the average daily count of pressure medications from 2.6 to 1.5 and raised systolic pressure by about 4 points, with side effects no more common than under usual care.
- Among frail nursing-home residents aged 80 and older on two or more blood-pressure drugs with low readings, a gradual taper left survival unchanged over up to four years, 61.7% versus 60.2% mortality.
- A separate randomized trial in over-80s living at home found the same thing when one drug was withdrawn: no rise in deaths or hospitalizations over four years.
- Both trials concern very old adults whose pressure was already low or controlled. Neither says anything about treating high blood pressure in younger or healthier people.
References
- Benetos A, Gautier S, Freminet A, et al. Reduction of Antihypertensive Treatment in Nursing Home Residents. New England Journal of Medicine. 2025;393(20):1990–2000. link
- Sheppard JP, Temple E, Wang A, et al. Effect of antihypertensive deprescribing on hospitalisation and mortality: long-term follow-up of the OPTiMISE randomised controlled trial. The Lancet Healthy Longevity. 2024;5(8):e563–e573. link