Nadal M, Wikstrom L, Allgulander S. Once hypertensive, always hypertensive? A three year follow-up after stopping medication. Scandinavian Journal of Primary Health Care, 1994:62-64
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/8009103
Full text article: https://www.tandfonline.com/doi/abs/10.3109/02813439408997059
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 86 enrolled, 52 completed
Age: 74 years (range 68 to 82 years) Sex: 53 female, 33 male Participants with dementia: No Inclusion criteria: · Taking medicine to control hypertension · Patient at the participating hypertension clinic Exclusion criteria: · History of myocardial infarction or stroke during the previous 12 months · Plasma creatinine 2 200 mmol/liter · Simultaneous chronic disease with short life expectancy · Insulin-dependent diabetes mellitus · Mental illness · Systolic blood pressure > 220 mmHg or diastolic > 110 Country: Sweden Setting: Community – out-patient Hypertensive Unit of the Department of Geriatrics, Skelleftea Hospital, Sweden. |
| Interventions | Medicine: Antihypertensives – beta-blockers n=29, diuretics n=19, other n=4
Withdrawal schedule: Not described |
| Outcomes | Reverted to hypertensive during the 1 month wash-out period
Successful deprescribing from 1 month to 36 months Differences in those that restarted and those who were successfully deprescribed Serious adverse events |
| Dates | Dates: Not described
Follow-up duration: Three years |
| Funding sources | Not described |
| Notes | The 52 participants who were not hypertensive one month after deprescribing formed the follow-up group and continued without medication. |
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 | There were no concurrent controls. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | Not blinded. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 5 out of 5 | It is not clear if or how many people dropped out over the study or for what reason. |
| Selective reporting (reporting bias) | Unclear risk | There was a pre-specified protocol though it is not known if the authors adhered to the pre-specified analysis plan, as this was not published. The stated objective was not explicit, and, therefore, it is unclear if there was selective outcome reporting. |
| Confounding (non-randomized) | 5 out of 5 | No concurrent controls. |
| Other bias | Low risk | |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | The intervention group was a selected group of users. |
| Selection of the non-exposed cohort | There was no concurrent control group. | |
| Ascertainment of exposure | Ascertainment of exposure was by structured interview.
|
|
| Demonstration that outcome of interest was not present at start of study | The outcome of interest was demonstrated not to be present at the start of the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The study controls for antihypertensive discontinuation. |
| Outcome bias | Assessment of outcome | Outcome assessment was by record linkage. |
| Was follow-up long enough for outcomes to occur | The follow-up duration of three years was long enough for outcomes to occur.
|
|
| Adequacy of follow-up of cohorts | There was no statement on follow-up or participants and drop-outs. | |
Leave a Reply