Hansen AG, Jensen H, Laugesen LP, et al. Withdrawal of antihypertensive drugs in the elderly. Acta Medica Scandinavica 1983;214:178-85
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/6362346
Full text article: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.0954-6820.1983.tb19342.x
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 168 enrolled, 105 completed
Age: 75 years Sex: Not described Participants with dementia: No Inclusion criteria: · Diastolic blood pressure > 105 mmHg if 5o-59 years old OR · Diastolic blood pressure >110 mmHg if 60 years of age or older. · Aged 60 years or over · History of hypertension · Diastolic BP < 110mmHg 3 weeks after withdrawal of treatment Exclusion criteria: · Diastolic BP > 110mmHg 3 weeks after withdrawal of treatment Country: Denmark Setting: Community – not further described |
| Interventions | Medicines: Antihypertensives
Withdrawal schedule: Not described |
| Outcomes | Successful deprescribing
Screening normotensive |
| Dates | Dates: Not described
Follow-up duration: 12 months |
| Funding sources | Not described |
| Notes | Limited detail |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Single-arm, non-randomized study |
| Allocation concealment (selection bias) | High risk | Open single-arm study. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | This was not a blinded study. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 5 out of 5 | 12 patients failed to appear for re-examination with no reason given.
Participants were excluded if they were hypertensive after 3 weeks of no antihypertensive treatment, which alters outcomes. |
| Selective reporting (reporting bias) | Unclear risk | There is no evidence of a pre-specified protocol and analysis plan, and the objectives are insufficiently stated to make it clear if there is selective outcome reporting.
The primary outcome measure was not clearly stated. Ultimately, reduction of medication was being tested but the measurement of outcomes appears jumbled particularly because a new diastolic BP limit was imposed during the study for an additional test. |
| Confounding (non-randomized) | 5 out of 5 | Single-arm study, so no control group to ascertain external confounding factors.
Confounders are not sufficiently discussed. |
| Other bias | Unclear risk | The methods section is insufficiently developed to ascertain other sources of bias. |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | The intervention group is a representative sample of patients with hypertension or a history of hypertension. |
| Selection of the non-exposed cohort | As a before-and-after study, there is no concurrent control group.
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| Ascertainment of exposure | There is no description of how ascertainment of exposure was established.
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| Demonstration that outcome of interest was not present at start of study | It was demonstrated that the outcome of interest was not present at the start of the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controls for deprescribing antihypertensive treatment. |
| Outcome bias | Assessment of outcome | Assessment of outcome by secure record. |
| Was follow-up long enough for outcomes to occur | The follow-up duration would probably have been sufficient for the outcome of interest to occur. | |
| Adequacy of follow-up of cohorts | Follow-up rate below ideal and no description of those lost. | |
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