Prestigious Dhole-Eddlestone Memorial Prize awarded to study on deprescribing blood pressure treatments in older adults with dementia

The prestigious Dhole-Eddlestone Memorial Prize has been awarded to an Age and Ageing journal article examining the effects of discontinuing blood pressure treatments in older adults with dementia living in nursing homes. The prize is awarded annually to the most deserving medical research relating to the needs of older people, published in Age and Ageing, the scientific journal of the British Geriatrics Society (BGS) in the preceding year. The award is funded by a legacy donation from late BGS member, Dr Manindra Kumar Dhole, who died in 1977. The £1,000 prize commemorates the anniversary of his marriage with Dr Margaret Eddlestone, celebrated each year on the 14 January.

The Age and Ageing article, ‘Effects of the discontinuation of antihypertensive treatment on neuropsychiatric symptoms and quality of life in nursing home residents with dementia (DANTON): a multicentre, open-label, blinded-outcome, randomised controlled trial’, was published in July 2024.

The study was led by researchers from the Leiden University Medical Centre. The randomised controlled trial assessed whether the discontinuation of blood pressure lowering medication reduced neuropsychiatric symptoms of dementia, such as agitation, depression and sleep impairment, and whether it maintained the quality of life of the resident.  

The study found that discontinuing treatment for high blood pressure did not help with the neuropsychiatric dementia symptoms and suggests that discontinuing the medication might be harmful. These findings challenge the common practice of deprescribing. In this case, previous research had suggested that continuing blood pressure lowering medication may exacerbate dementia symptoms and decrease quality of life. 

While the article acknowledges the need for replication in a larger trial before it could be considered definitive, there is sufficient evidence to suggest that clinical teams need to carefully consider whether to discontinue blood pressure medication proactively in people living with dementia.

Rosalinde Poortvliet, senior researcher, GP and epidemiologist at Leiden University Medical Centre, lead author on this study, said:

There is a general feeling among physicians that discontinuation of medication is better for frail older adults. This was also our hypothesis when starting the trial, therefore, we were surprised by the results.

We are very honoured to have won this award. With this research, we hope not only to provide doctors with more information on the effects of discontinuation of antihypertensive treatment in nursing home residents with dementia, but also to encourage doctors and researchers to research treatments or refraining from using treatments in this population.

This hypothesis is one to test. To date, little sound qualitative random controlled trials in care homes have been executed, but this trial shows that it is possible due to the unique Dutch academic nursing home network structure. We’d like to offer special thanks to the University Network for the Care sector South Holland (UNC-ZH).”

Professor Terry Quinn, David Cargill Chair and Honorary Consultant Physician in Geriatric and Stroke Medicine, one of the judging panel members, said:

This year, we were lucky to have many excellent papers to consider for the Dhole-Eddleston Memorial Prize, and they were all potentially worthy of the accolade. After a lot of discussion, we selected the DANTON trial.

This was clearly a substantial project. We recognise that conducting trials in a nursing home setting is challenging and we admired the transparency of the reporting.

The result of the trial, that stopping blood pressure medication may be harmful, challenges usual practice in older adult care. When we select papers for the BGS Age and Ageing journal, we always favour those that will make clinicians stop and think about their practice, and this paper certainly does that.”

Professor Roy Soiza, Editor-in-Chief of Age & Ageing, said:

Our journal is committed to supporting greater inclusion of older people and care home residents in clinical trials, as evidence-based medicine relies on study populations matching those seen in the real world. The DANTON trial shows such trials are feasible and lead to important discoveries that can change clinical practice, improving outcomes and efficiency.”