23 January 2026
Press
Is it possible to reduce treatments for the most frail elderly without endangering their health? A large-scale French clinical study, RETREAT-FRAIL, has produced reassuring results and opened up concrete prospects for improving the quality of life of EHPAD residents. It shows that a controlled reduction in antihypertensive treatment in very frail elderly people is possible without increasing mortality or serious complications. The results were recently published in the New England Journal of Medicine*.
A central question in geriatrics: should we always treat "more"?
As patients age, they often accumulate several chronic illnesses and numerous medications. This polymedication, common in EHPAD, exposes them to adverse effects, falls, hospitalizations and impaired quality of life.
RETREAT-FRAIL, is a 100% French clinical trial, promoted by the AP-HP, designed and coordinated by Pr Athanase Benetos's geriatrics team (INI-CRCT/F-CRIN/CHRU Nancy), entirely financed by public funds (national Clinical Research Hospital Program, RHU Fight Heart Failure Program, ARS Grand Est). This clinical trial, structured around 14 university hospital teams and 110 EHPAD throughout France, addressed a question that had long remained without a solid scientific answer: is it possible to reduce certain treatments in the very elderly, without risk to their health?
An international first in EHPAD residents
RETREAT-FRAIL is the first randomized clinical trial at international level to have assessed, over the long term, the impact of progressive reduction of antihypertensive treatments in very old and frail EHPAD residents. The study included 1,048 people aged 80 and over, treated with at least two antihypertensives and with already low blood pressure. Participants, followed for over three years, were divided into two groups: one benefiting from a progressive, protocolized reduction in treatment, the other continuing with usual care.
Clear, reassuring results
The results show that reducing the number of antihypertensive drugs does not increase mortality, does not lead to more cardiovascular events, does not impair quality of life or functional status, and does not increase the risk of falls or serious adverse events either. In the group that benefited from deprescribing, the mean number of antihypertensives fell from 2.6 to 1.5, with a slight rise in blood pressure, with no adverse clinical consequences.
A particularly encouraging signal was observed in the most frail patients, who could derive specific benefit from this more individualized approach. Furthermore, a lower number of COVID-19-related deaths was observed in the group that benefited from therapeutic reduction.
A contribution to the development of clinical research on very old and frail patients, particularly EHPAD residents
Clinical trials carried out to date have mainly recruited robust, healthy patients, systematically excluding frail, dependent elderly patients, particularly EHPAD residents who nevertheless consume a large number of drugs. The RETREAT-FRAIL study demonstrates that, while randomized controlled studies with long-term follow-up are admittedly difficult in these patients, they are perfectly feasible, and above all, essential for assessing the benefit-risk ratio of therapeutic strategies proposed for long-term preventive purposes particularly in the cardiometabolic field.
Towards more personalized medicine for the elderly
The study robustly demonstrates that reasoned treatment reduction, when carried out according to precise rules and under medical supervision, does not compromise patient safety. These findings represent a major advance in the fight against polymedication, a central public health issue in the elderly, and encourage more personalized medicine, focused on the patient's actual condition and needs rather than standardized therapeutic goals. "These results are particularly encouraging. They show that it is possible to adapt treatments in the very frail elderly, without loss of chance, provided a rigorous medical framework is respected." comments Pr Athanase Benetos, member of the INI-CRCT network (F-CRIN), professor of internal medicine and geriatrics at the CHRU de Nancy in charge of coordinating the study.
A post-randomization follow-up is currently underway to assess the longer-term effects of this strategy, in close collaboration with the care teams at the participating EHPADs.
*Benetos A, Gautier S, Freminet A, et al: Reduction of antihypertensive treatment in nursing home residents. N Engl J Med. 2025;393:1990-2000.
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RETREAT-FRAIL, the players: Design: Geriatrics team at CHRU de Nancy led by Pr Athanase Benetos (study PI and first author), |
Created and accredited by F-CRIN in 2014, coordinated by Pr Patrick Rossignol (nephrologist, vascular physician and professor of therapeutics, head of the nephrology-hemodialysis medical specialties department at the Princess Grace Hospital in Monaco), Pr Nicolas Girerd (cardiologist, Professor of Therapeutics at CHRU Nancy and coordinator of the CIC Plurithématique de Nancy), Pr Bénédicte Sautenet (PU-PH Thérapeutique, nephrologist at CHRU Tours) and Pr Jean-Sébastien Hulot (Professor of Medicine and cardiologist at Hôpital Européen Georges Pompidou), INI-CRCT is a research network of excellence, supported by Fondation Id+ Lorraine, to improve the cardiovascular prognosis of kidney failure patients. Its multidisciplinary approach, unique at international level, brings together French experts in cardio renal diseases, as well as an ARO (Academic Research Organization - Fondation FORCE), the Inserm-DGOS Cardiovascular CIC network, hemodialysis centers, heart failure networks, the Agence de la Biomédecine, and the Fondation Id+ of the Université de Lorraine. Its coordination unit has been ISO9001-certified since 2019. Since its creation, the INI-CRCT network has contributed to over 700 publicationshttps://pubmed.ncbi.nlm.nih.gov/?term=INI-CRCT.
For more information: https://www.inicrct.fr
Set up in 2012, F-CRIN (French Clinical Research Infrastructure Network) is a national platform dedicated to the development of French clinical research. It is led by Inserm in association with hospitals, healthcare manufacturers and universities, and supported by the French National Research Agency and the Ministry of Health. Its mission is to federate the players involved in clinical research in order to boost the competitiveness and attractiveness of French research on the international stage, and to develop the expertise of professionals by pooling know-how, resources and means, thereby accelerating the adoption of new practices and the development of new therapeutic solutions. "Federating to excel and innovate" is F-CRIN's ambition and motto. Today, F-CRIN is based on a federative model structured around 28 components: 26 thematic research and clinical investigation networks, a multiservice platform available to sponsors and investigators to support their trials, and a national coordination unit, the infrastructure headquarters, based in Toulouse. With more than 2,000 professionals pooling their expertise and resources, F-CRIN is also the French interface for the European clinical research network ECRIN, promoting the participation of French teams and centers in multinational clinical trials. For more information: https://www.fcrin.org
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