Browne, G.A., Griffin, T.P., O’Shea, P.M. and Dennedy, M.C. (2016), β‐Blocker withdrawal is preferable for accurate interpretation of the aldosterone–renin ratio in chronically treated hypertension. Clin Endocrinol, 84: 325-331.
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/26300226
Full text article: https://onlinelibrary.wiley.com/doi/full/10.1111/cen.12882
| Methods | Study design: Non-randomised controlled study
Number of groups: 2 |
| Participants | Number of participants: 29
Active group: 19 Control group: 10 Age: median 65 Sex: 9 female (31%) Participants with dementia: Unclear Inclusion criteria: Type 2 diabetes mellitus Chronic hypertension ≥5 years Treated with beta blockers ≥1 year Exclusion criteria: Taking direct renin inhibitors, mineralocorticoid antagonists, amiloride therapy or centrally acting antihypertensives Prior diagnosis of coronary artery disease, heart failure, PA, phaeochromocytoma, low renin hypertension, renal artery stenosis, or CKD>stage III Women taking oestrogens or progestins as HRT or OCP Concomitant medicines: metformin, sulphonylurea, GLP-1 inhibitors, DPP-4 inhibitors, insulin, ACEI, ARBs, thiazide diuretics, loop diuretics, calcium channel blockers, alpha-1 adrenoreceptor antagonists Country: Ireland Setting: Hospital diabetes outpatient clinic |
| Interventions | Medicine: Beta blocker
Withdrawal schedule: ‘tapered and then withdrawn’, other anti-hypertensive medications optimised Comparator: Non-withdrawal of beta blocker |
| Outcomes | Blood pressure (SBP and DBP) control
Aldosterone-renin ratio |
| Dates | Dates: July 2014 – March 2015
Follow-up duration: 3 months |
| Funding sources | Nil reported |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High | Beta blockers were withdrawn in patients not taking these agents for cardiac indication – the remainder of patients made-up the other group |
| Allocation concealment (selection bias) | High | Beta blockers were withdrawn in patients not taking these agents for cardiac indication – the remainder of patients made-up the other group |
| Blinding of participants and personnel (performance bias) | High | Unclear if patients were aware of allocation, but personnel carrying out deprescribing were |
| Blinding of outcome assessment (detection bias) | Unclear | Unclear if outcome assessors knew of study allocation |
| Incomplete outcome data (attrition bias) | Low | No loss to follow-up reported |
| Selective reporting (reporting bias) | Unclear | No protocol |
| Confounding (non-randomized) | High | No confounders reported |
| Other bias | Low | Discussion reported BP differences between groups however no statistical output reported to support this |
| Selection bias | Representativeness of the exposed cohort | B: somewhat representative of hypertensive patients receiving beta-blocking therapy for non-cardiac indications |
| Selection of the non-exposed cohort | B: drawn from a different source, as these patients had beta blockers for cardiac indications | |
| Ascertainment of exposure | A: secure record | |
| Demonstration that outcome of interest was not present at start of study | A: yes | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | A: study controls for withdrawal of beta-blocker |
| Outcome bias | Assessment of outcome | B: record linkage |
| Was follow-up long enough for outcomes to occur | B: no | |
| Adequacy of follow-up of cohorts | A: complete for all subjects | |
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