Fotherby MD, Potter JF. Possibilities for antihypertensive drug therapy withdrawal in the elderly. Journal of Human Hypertension 1994;8:857-63
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/7853330
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 78 enrolled, 64 completed
Age: 76 ± 5 years (range 65 to 84 years) Sex: 39 female, 35 male Participants with dementia: No Inclusion criteria: · Treated pharmacologically for hypertension for more than one year · Fit, ambulantsubjects · 65 years and over · Screening: average of clinic-measured BPs from two visits being supine blood pressure of systolic <175 mmHg and diastolic < 100 mmHg Exclusion criteria: · Signs and symptoms of angina · Signs and symptoms of congestive heart failure · History of myocardial infarction or stroke in preceding 6 months · Renal impairment (defined as creatinine > 200 mmol/L) · Other medicines known to affect BP · Other diseases that would significantly affect survival (e.g. terminal illness) Country: England Setting: Community and hospital |
| Interventions | Medicine: Antihypertensives
Withdrawal schedule: Not described |
| Outcomes | Successful deprescribing |
| Dates | Dates: Not given
Follow-up duration: 12 months |
| Funding sources | British Heart Foundation |
| Notes |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Not a randomized study. |
| Allocation concealment (selection bias) | High risk | Open single-arm study – allocation not concealed. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Open single-arm study. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 1 out of 5 | The drop-outs are accounted for, and the data appears to be present. |
| Selective reporting (reporting bias) | Unclear risk | There was a pre-specified protocol as ethical approval was granted. However, it is not certain if there was a detailed analysis plan that was followed. The stated outcomes were reported and seemed sensible. The primary outcome measurement was simple and clearly reported upon. |
| Confounding (non-randomized) | 5 out of 5 | Single-arm study, not controlled for potential confounding factors.
Many confounders were consideredand controlled for in the statistical analysis. The weakness was a lack of controls. |
| Other bias | Unclear risk | Limited detail to ascertain if there were other potential risks of bias. |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Somewhat representative of fit, ambulant hypertensive patients taking antihypertensive medication. Representativeness of the exposed cohort difficult to ascertain due to limited detail. |
| Selection of the non-exposed cohort | No concurrent control group.
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| Ascertainment of exposure | Secure record. | |
| Demonstration that outcome of interest was not present at start of study | Yes. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controls for antihypertensive medicine. |
| Outcome bias | Assessment of outcome | Assessment of outcome by record linkage. |
| Was follow-up long enough for outcomes to occur | Follow-upduration was probably long enough for the outcomes to occur. | |
| Adequacy of follow-up of cohorts | Subjects lost to follow-up unlikely to introduce bias. | |
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