Generalizability of Blood Pressure Lowering Trials to Older Patients: Cross‐Sectional Analysis

BACKGROUND/OBJECTIVES Randomized controlled trials are used to inform clinical guidelines on the management of hypertension in older adults, but it is unclear to what extent these trials represent the general population attending routine clinical practice. This study aimed to define the proportion a...

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Vydáno v:Journal of the American Geriatrics Society (JAGS) Ročník 68; číslo 11; s. 2508 - 2515
Hlavní autoři: Sheppard, James P., Lown, Mark, Burt, Jenni, Temple, Eleanor, Lowe, Rebecca, Ashby, Hannah, Todd, Oliver, Allen, Julie, Ford, Gary A., Fraser, Rosalyn, Heneghan, Carl, Hobbs, F.D. Richard, Jowett, Sue, Little, Paul, Mant, Jonathan, Mollison, Jill, Payne, Rupert, Williams, Marney, Yu, Ly‐Mee, McManus, Richard J.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Hoboken, USA John Wiley & Sons, Inc 01.11.2020
Wiley Subscription Services, Inc
Témata:
Adults
Aged, 80 and over
Antihypertensive Agents - therapeutic use
Blood Pressure
cardiovascular disease
Clinical medicine
Clinical practice guidelines
Clinical trials
Criteria
Cross-Sectional Studies
Decision making
Drugs
electronic health records
Electronic medical records
Eligibility Determination
Female
Frailty
General Practice - statistics & numerical data
Generalizability
Humans
Hypertension
Hypertension - drug therapy
Male
Medical decision making
Medical records
Medical research
Medical treatment
Older people
Patient Selection
Patients
Prescription drugs
randomized controlled trials
Randomized Controlled Trials as Topic - statistics & numerical data
Statistical analysis
Statistics
cardiovascular disease
frailty
electronic health records
randomized controlled trials
hypertension
ISSN:0002-8614, 1532-5415, 1532-5415
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Shrnutí:BACKGROUND/OBJECTIVES Randomized controlled trials are used to inform clinical guidelines on the management of hypertension in older adults, but it is unclear to what extent these trials represent the general population attending routine clinical practice. This study aimed to define the proportion and characteristics of patients eligible for hypertension trials conducted in older people. DESIGN Cross‐sectional study. SETTING A total of 24 general practices in England. PARTICIPANTS Anonymized electronic health record data from all individuals aged 80 and older. MEASUREMENTS Descriptive statistics were used to define the proportion and characteristics of patients eligible for two previous medication intensification trials (HYVET, SPRINT) and one medication reduction trial (OPTiMISE). A logistic regression model was constructed to estimate predictors of eligibility for each trial. RESULTS Of 15,376 patients identified, 268 (1.7%; 95% confidence interval [CI] = 1.5–2.0%), 5,290 (34.4%; 95%CI = 33.7–35.2%), and 3,940 (25.6%; 95%CI = 24.9–26.3%) were eligible for the HYVET, SPRINT, and OPTiMISE trials, respectively. Between 5.6% and 30.7% of exclusions from each trial were due to eligibility criteria excluding those with high or uncontrolled blood pressure. Frailty (odds ratio [OR] = .44; 95%CI = .36–.54 [OPTiMISE]), cardiovascular polypharmacy (OR = .61; 95%CI = .55–.68 [SPRINT]) and multimorbidity (OR = .72; 95%CI = .64–.82 [SPRINT]) were associated with a lower likelihood of being eligible for one or more of the trials. CONCLUSION A possible unintended consequence of blood pressure criteria used by trials attempting to answer different primary questions is that for many older patients, no trial evidence exists to inform treatment decisions in routine practice. Caution should be exercised when applying results from existing trials to patients with frailty or multimorbidity. See related editorial by Jeff D. Williamson in this issue.
Bibliografie:in this issue.
Jeff D. Williamson
Part of these data were presented at these scientific meetings: Australia Association for Academic Primary Care, oral presentation, Adelaide, July 2019; European Society of Cardiology, poster presentation, Paris, August 2019; and North American Primary Care Research Group, poster presentation, Toronto 2019; All conference attendees were funded by the National Institute for Health Research School for Primary Care Research.
See related editorial by
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ISSN:0002-8614
1532-5415
1532-5415
DOI:10.1111/jgs.16749