Gulla C, Flo E, Kjome RL, Husebo BS. Deprescribing antihypertensive treatment in nursing home patients and the effect on blood pressure. J Geriatr Cardiol. 2018;15(4):275–283.
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/29915617
Full text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997621/
| Methods | Study design: Multi-centre cluster randomised controlled trial
Number of groups: 2 |
| Participants | Number of participants: 72 RACF units (clusters), 295 residents
Active group: 164 Control group: 131 Age: 87 ± 7.6 Sex: 205 female (69%) Participants with dementia: 220 Inclusion criteria: ≥65 year Taking an antihypertensive medication Exclusion criteria: Limited life expectancy Diagnosis of schizophrenia Concomitant medicines: mean 9.2 ± 3.4 Country: Norway Setting: 32 residential aged care facilities |
| Interventions | Medicine: Antihypertensives
Intervention: Two day educational seminar for unit managers, nurse champions, physicians and pharmacists, education disseminated by attending nurses to remaining unit staff. Education included medication review and rationalisation Withdrawal schedule: Dose taper or withdraw if SBP<160mmHg Comparator: Usual care |
| Outcomes | Number of antihypertensives reduced
Change in SBP Hospitalisation Mortality |
| Dates | Dates: Aug 2014 – Dec 2015
Follow-up duration: 9 months |
| Funding sources | Norwegian Research Council and RE Hegermann’s Endowment |
| Notes | Post hoc analysis/secondary outcome reporting from the COSMOS trial |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | Low | Random number sequence used to randomise units (SPSS, IBM), stratified by geographical locations |
| Allocation concealment (selection bias) | High | Allocation concealment not described |
| Blinding of participants and personnel (performance bias) | High | Open study without blinding of personnel, blinding of participants not discussed |
| Blinding of outcome assessment (detection bias) | High | Outcome assessors were the nurses involved on the units |
| Incomplete outcome data (attrition bias) | Low | Loss to follow up described |
| Selective reporting (reporting bias) | Unclear | Study protocol published and clinical trial registered, however this secondary analysis of hypertensive medications not included in either. |
| Other bias |
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