Evidence map›Paper›PMID 32898307›Full record

ArticleJournal of the American Geriatrics Society2020

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

James P Sheppard, Mark Lown, Jenni Burt, Eleanor Temple, Rebecca Lowe, Hannah Ashby, Oliver Todd, Julie Allen, Gary A Ford, Rosalyn Fraser and 10 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  10. Frailty and blood pressure in older adults: rethinking risk and treatment strategies.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Article
  11. Article
  12. Article
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  14. Article
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  17. A comparison of sodium-glucose co-transporter 2 inhibitor kidney outcome trial participants with a real-world chronic kidney disease primary care population.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors.

James P SheppardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-4461-8756
Mark LownPrimary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
Jenni BurtThe Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.
Eleanor TempleNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Rebecca LoweNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Hannah AshbyNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Oliver ToddAcademic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
Julie AllenNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Gary A FordRadcliffe Department of Medicine, University of Oxford, Oxford, UK.
Rosalyn FraserNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Carl HeneghanNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sue JowettInstitute of Applied Health Research, University of Birmingham, Birmingham, UK.
Paul LittlePrimary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
Jonathan MantPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Jill MollisonNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Rupert PayneCentre for Academic Primary Care, University of Bristol, Bristol, UK.
Marney WilliamsPatient and Public Involvement Representative, London, UK.
Ly-Mee YuNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

Funding

Department of Health NIHR-RP-02-12-015Department of Health NIHR-RP-R2-12-015Department of Health Oxford CLAHRC P2-501Department of Health P2‐501Department of Health SPCR 335The Dunhill Medical Trust RTF107/0117Wellcome Trust 211182Wellcome Trust 211182/Z/18/Z
6 · The paper itself

Abstract

BACKGROUND/

objectivesRandomized 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.

designCross-sectional study.

settingA total of 24 general practices in England.

participantsAnonymized 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.

resultsOf 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.

conclusionA 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.

Indexed as

Blood PressureAged, 80 and overAntihypertensive AgentsCross-Sectional StudiesEligibility DeterminationFemaleFrailtyGeneral PracticeHumansHypertensionMalePatient SelectionRandomized Controlled Trials as TopicAntihypertensive Agentscardiovascular diseaseelectronic health recordsfrailtyhypertensionrandomized controlled trials

Identifiers

PMID32898307
PMCPMC7618156

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.