Lernfelt B, Landahl S, Svanborg A, et al. Overtreatment of hypertension in the elderly? Journal of Hypertension 1990;8(5):483-90.
Pubmed link: https://www.ncbi.nlm.nih.gov/pubmed/2163425
| Methods | Study design: Historical cohort study
Number of groups: Two groups |
| Participants | Number of participants: 25 enrolled, 14 completed
Age: Not described. Sex: 15 female, 10 male Participants with dementia: No Inclusion criteria: · Treated for hypertension · 70 years or older · Community-dwelling resident in Gothenburg, Sweden · Participation in one of three cohorts of a longitudinal study of hypertension in the elderly Exclusion criteria: · Systolic blood pressure of > 175mmHg and/or diastolic blood pressure of > 95 mmHg at the medical examination referred to above · Cardiovascular disease, defined as a history of myocardial infarction, angina pectoris, stroke or findings in the case records indicating other serious cardiovascular disease such as congestive heart failure, intermittent claudication or valvular heart disease · ECG abnormalities · Increased heart volume during chest radiography · Other serious diseases which were likely to deteriorate during the study Country: Sweden Setting: Community – a systematically chosen sample of 800 people from the city of Gothenburg (25% of the total 70-year-old population) was invited to participate |
| Interventions | Medicine: Antihypertensives (previous treated for a mean 11.6 years, range 4-30 years).
· Monotherapy with: o Diuretics (30% of the men and 32% of the women) o B-blocking agents (20% of the men and 23% of the women). · Combination therapy with two or more drugs (44%) mostly B-blockers and diuretics Withdrawal schedule: Not described Comparator: “…did not use a matched control group in the present study but compared our results with a 4-year follow-up of 75-year-old men and women who were not being treated for hypertension and had no cardiovascular disorders.” |
| Outcomes | Blood pressure
Successful deprescribing Left ventricular function and other surrogate measures |
| Dates | Dates: 1981 to 1982
Follow-up duration: Four years |
| Funding sources | Swedish Ministry of Health and Social Affairs – Commission for Social Research, the Swedish Medical Research Council, the Gothenburg Medical Services Administration, the Gothenburg Administration of Social Services and Wilhelm and Martina Lundgren’s Foundation. Special grants for the intervention program were given by the Swedish Council for Planning and Coordination of Research, the Swedish Medical Research Council, the Swedish Council for Building Research, the Bank of Sweden Tercentenary Foundation, the Gothenburg Medical Services Administration, the Gothenburg Administration of Social Services and the Gothenburg Administration of Sports and Leisure. The non-invasive studies were supported by grants from the Swedish Heart-Lung Foundation, Stockholm. |
| Notes | Additional information sought to find mean age of participants, but not received. |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | It is an observational study. |
| Allocation concealment (selection bias) | High risk | No concurrent control group. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Blinding not described, probably not done. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 1 out of 5 | It appears that there was no missing data. |
| Selective reporting (reporting bias) | 5 out of 5 | The outcome measures were vague – the null hypothesis was “no difference between groups” and then several measurements were proposed. Reporting matched the method. |
| Confounding (non-randomized) | 5 out of 5 | The relationship between this study and the longitudinal study is unclear.
The control group was not equivalent to the deprescribing group, so the imbalance means that confounding is a high risk of bias. |
| Other bias | Low risk | |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | Participants were a selected group of users. |
| Selection of the non-exposed cohort | The concurrent control group was not equivalent. | |
| Ascertainment of exposure | Ascertainment of exposure was by secure record. | |
| Demonstration that outcome of interest was not present at start of study | The outcome was not present at the start of the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | It was unclear what the study controlled for; it possibly controlled for hypertension or medicine use. |
| Outcome bias | Assessment of outcome | Outcome assessment was by record linkage. |
| Was follow-up long enough for outcomes to occur | Follow-up was probably long enough for outcomes to occur. | |
| Adequacy of follow-up of cohorts | Follow-up rate was unclear but probably complete. | |
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