AbstractBackgroundThere is mixed evidence about the impact of long‐term management with hypnotic medications on blood pressure (BP).AimTo estimate the effect of short‐ and long‐term management with benzodiazepine and z‐drugs (BZD) on BP.MethodOpen cohort study using deidentified electronic health records of 523,486 adult regular patients (42.3% males; mean age 59.0 ± 17.0 years) annually attending 402 Australian general practices between 2016 to 2018 (MedicineInsight database). Average treatment effects (ATE) of recorded incident BZD prescriptions in 2017 on systolic (SBP) and diastolic (DBP) BP after starting these prescriptions were computed using augmented inverse probability weighting (AIPW).ResultsIn 2017, 16,623 new cases of short‐term management with BZD and 2532 cases of long‐term management with BZD were identified (incidence 3.2% and 0.5%, respectively). The mean BP among those not treated with BZD (reference group) was 130.9/77.3 mmHg. Patients prescribed short‐term BZD showed a slightly higher SBP (ATE 0.4; 95% CI 0.1, 0.7) and DBP (ATE 0.5; 95% CI 0.3, 0.7), while those on long‐term BZD prescriptions showed lower SBP (ATE ‐1.1; 95% CI −2.0, −0.2), but no effect on DBP (ATE −0.1; 95% CI −0.8, 0.5). However, long‐term BZD prescriptions showed a stronger BP‐lowering effect among patients aged 65+ years (SBP ATE −2.5 [95% CI −3.8, −1.3]; DBP ATE −1.0 [95% CI −1.7, −0.2]), but almost no effect was observed among younger patients.ConclusionLong‐term management with BZD had a BP‐lowering effect among older patients. These findings add new evidence to current recommendations on limiting long‐term BZD management in the elderly.