Short summary

Since blood pressure often decreases with age, antihypertensive medications often need to be deprescribed in older persons with hypertension. Some persons are even normotensive after discontinuing their antihypertensive treatment. For some persons the hypertension diagnosis may thus no longer apply and dediagnosing could be relevant.

Rationale

Little is known about if and how general practitioners (GPs) have conversations about the hypertension diagnosis and its relevance when antihypertensive medications are deprescribed in older persons. Dediagnosing, that is, the removal of diagnoses that do not contribute to reducing a person's suffering, has been suggested as a counter initiative to the overuse of diagnoses. While deprescribing have been studied in multiple settings and population, no previous research has, to our knowledge, explored dediagnosing in clinical practice. There can be several reasons for deprescribing, that is, reducing and/or stopping, antihypertensive treatment. If the patient is normotensive after discontinuing antihypertensive medications, the hypertension diagnosis could be dediagnosed. Also in cases were an older person has an acceptable blood pressure based on frailty, risk of adverse events and frailty, the hypertension diagnosis is not relevant anymore and could be dediagnosed. The main aim of this qualitative study is to explore general practitioners' experiences and perspectives on diagnosis conversations and deprescribing in older persons over 80 years of age with hypertension.

Description of the cohort

We will recruit Danish general practitioners through our professional network. Snowball sampling will also be used to reach additional participants. Inclusion criteria for GPs: Care for persons 80 years of age or older with hypertension diagnosis who are currently using or have previously used antihypertensive medications. An interview guide for GPs have been developed and will be used. The interviews will be audiotaped, transcribed and analysed according to the Dediagnosing Framework.

Data and biological material

Individual semistructured interviews.

Collaborating researchers and departments

Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark

Department of Public Health, Section of General Practice, University of Copenhagen

Oslo University Hospital, Oslo, Norway