Deprescribing antihypertensives with weekly taper intervals in long-term care, secondary data analysis of OptimizeBP data
Bibliographic record
Abstract
Context: There is minimal evidence about the optimal taper interval for antihypertensive deprescribing in frail older adults. A shorter taper interval would be advantageous for implementation. Objective: To examine the deprescribing decision using 1-week taper intervals compared to 2-week taper intervals in the frail older adult population. Study design and analysis: Secondary data analysis. University of Alberta Ethics (Pro00097312). Dataset: OptimizeBP blood pressure measurements from 2021–2024. OptimizeBP is an antihypertensive deprescribing trial in long-term care. In the trial pharmacists/nurse practitioners deprescribed in 2-week taper intervals and used 4 blood pressure measurements from the previous 2 weeks to decide whether to 1) continue to taper (average systolic BP ≤145 mm Hg); 2) monitor for 2 additional weeks (average systolic BP 146–150 mm Hg), or 3) prescribe the previous dose (average systolic BP >150 mm Hg). Most pharmacists/nurse practitioners used an optional tracking sheet to track their deprescribing and submitted them regularly to the study team. Population studied: Long-term care residents (≥70 years old, systolic BP <135 mm, and no diagnosis of congestive heart failure) in OptimizeBP. Outcome measure: Percentage of deprescribing decisions that would stay the same if the OptimizeBP deprescribing algorithm is changed to a 1-week taper interval instead of the 2-week taper interval that was used in the trial. Results: In the tracking sheets received, there was a total of 393 2-week tapers; 270 tapers had sufficient data for analysis (ace inhibitors [n=103]; calcium channel blockers [n=83]; ARB [n=65]; beta-blockers [n=9]; diuretics [n=10]). For 88% of tapers (n=239), the decision was the same using blood pressure measurements 1-week and 2-weeks post-reduction (deprescribe: 231; monitor: 1; prescribe: 7). For 12% of tapers (n=31), the decision was different: In 8 cases, the 1-week decision was to deprescribe and the 2-week decision was to monitor/prescribe, and in 23 cases, the 1-week decision was to monitor/prescribe and the 2-week decision was to deprescribe. Conclusion: It may be feasible to deprescribe antihypertensives weekly for frail older adults. Further studies are needed to assess the reproducibility of these findings, whether the results are consistent among different dosages and classes of antihypertensives, and ultimately whether it is possible to discontinue antihypertensives without a taper.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.086 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.021 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".