Table 3.

Quotes about patient cases to illustrate antihypertensive medication (de)prescription

Start AHM	“We had a woman who just moved into an elderly home and came under our care. This is a woman of 91 years old. She came to live there with her husband, because of her age and because she had mild dementia. And when she arrived at the home for elderly they immediately measured her BP. She had a BP of 190 over 90. And so we gave her losartan 50 mg. […] So before that she had no AHM. Well you may think, that doesn’t do much, it isn’t that much. And so, we gave it. Then her BP immediately went to 140 over 80 and it remained there. And then she started complaining about terrible dizziness. And so I stopped it again.” (GP 12, female, >15 years’ experience as GP)
Intensify AHM	“This is also a very fit lady, but she is 86 years old. She had hydrochlorothiazide 12.5 mg and we increased that to 25 mg, because she had a BP of 180 over 80. And now with 25 mg it is 160 over 80. And she feels fine, so we leave it like this.” (GP 6, female, 10–15 years’ experience)
Continue AHM	“A patient of 92 years old, I think. Known with heart failure, poor mobility and COPD. She wants as little as possible. Also she doesn’t want to go to the hospital. And her BP is actually not much of an issue. Even though we know it is higher from time to time. When the oedema increases, her legs are swollen and she gets shortness of breath on exertion, well then we always measure the BP to see how much room we have to increase the furosemide. And there is always enough room, she always has a BP of 170–180. So that is nice, that we have that. But it never crossed my mind, when we have treated the fluid retention, to follow-up on her BP to say, let’s see if we should treat this structurally.” (GP 15, female, 10–15 years’ experience)
Deprescribe AHM	“Here I have the file of a 69 years old woman who has stage four lung cancer with progressive brain metastases. […] Because of a language barrier, her daughter explained that her mother often felt dizzy when getting up. She first called it vertigo, but after some further questioning it appeared more like light headedness. […] Her BP was repeatedly around 124 over 70. And what I did was, first I stopped the hydrochlorothiazide. Then her BP stayed low and she was still dizzy. And in the end I also stopped her losartan. […] And now her BP stays around 130 over 80, but now without any AHM. So in hindsight I think she was severely over-treated.” (GP 11, male, 0–5 years’ experience)

AHM, antihypertensive medication; BP, blood pressure; COPD, chronic obstructive pulmonary disease; GP, general practitioner.