Six months ago, an octogenarian patient told me he’d been having light-headedness. For decades, he’d taken a combination pill (two medicines in one) to keep his blood pressure below 140/90, numbers that have proved to be important in preventing heart attacks, strokes, and kidney failure. Light-headedness is common among older people on blood pressure drugs. “It’s as though I’m just going to pass out,” he told me. “My vision fades, and I get wobbly legs.” Fortunately, my patient’s episodes had passed without him actually falling.
He and I agreed that it would make sense to stop his medicine for a month and see what happened—something called a drug holiday. My patient agreed to buy a home blood pressure cuff, use it two or three times a week, and share the results with me. A month went by. His blood pressure, over multiple readings, was fine. And no more light-headedness.
I wrote him back: “Stay off the medication—it’s clear from your readings that you no longer need it.” He was thrilled. The decision saved him money and meant he could forget about one of his many daily pills.
I helped my patient avoid a drug-related problem like a fall and maybe a hip fracture—one of the banes of our aging population. What’s more, he and I pushed back against medical inertia, the tendency to keep things the way they are because it’s easier than making a change.
My patient’s experience and stories like his have led me to believe that there comes a point in aging when our physiology changes. No doubt there are many factors, such as our senior brains, stiffening blood vessels, and changes in the ratios of our hormones. Sometimes age brings more illness, but in other cases, problems seem to diminish.
Too often, we overlook the option of deprescribing, or discontinuing medications in older people who take a lot of them. A recent review of more than two dozen studies in which patients discontinued medications (including sedatives like Valium as well as blood pressure drugs) found that people did surprisingly well when they stopped taking them. Adverse symptoms abated, and their health generally improved.
As a doctor looking first to do no harm, I draw the following conclusion: Though I’m ready to believe the better low blood pressure outcomes promised by the latest research, I’m also going to look for opportunities to minimize the overuse of drugs in older patients. For many of us, less medicine means more health. (Here are the signs you’re taking too many prescriptions.)
However, keep in mind that you should never just decide to stop taking prescribed medicine on your own. Talk to your doctor and test out the theory that you may no longer need to take a pill. While my patient no longer needed his blood pressure medication, each individual is different and you may have a different reaction to stopping medication.