Evidence map›Paper›PMID 38342123›Full record

Trial reportThe lancet. Healthy longevity2024

Efficacy of decentralised home-based antihypertensive treatment in older adults with multimorbidity and polypharmacy (ATEMPT): an open-label randomised controlled pilot trial.

Jeannette Majert, Milad Nazarzadeh, Rema Ramakrishnan, Zeinab Bidel, Deborah Hedgecott, Abel Perez-Crespillo, Wendy Turpie, Naseem Akhtar, Moira Allison, Shishir Rao and 7 more

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The lancet. Healthy longevity, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
6.0field-weighted citation impact, top 3% of its field
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

3 citing papers in PubMed, 15 citations in OpenAlex.

  1. Trial
  2. Article
  3. Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes.International journal of environmental research and public health · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 6 institutions in 2 countries.

Jeannette MajertDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Milad NazarzadehDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Rema RamakrishnanNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Zeinab BidelDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Deborah HedgecottDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Abel Perez-CrespilloDeep Medicine, Oxford Martin School, Oxford, UK.
Wendy TurpieDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Naseem AkhtarDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Moira AllisonDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Shishir RaoDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK.
Bernard GudginPatient representatives ATEMPT, Oxford, UK.
Melanie McAuleyPatient representatives ATEMPT, Oxford, UK.
Christine A'CourtNuffield Department of Primary Health Sciences, University of Oxford, Oxford, UK.
Laurent BillotThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Dipak KotechaInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre & NHS West Midlands Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
John PotterDepartment of Medicine, University of East Anglia, Norwich, UK.
Kazem RahimiDeep Medicine, Oxford Martin School, Oxford, UK; Nuffield Department of Women's and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK. Electronic address: kazem.rahimi@wrh.ox.ac.uk.
University of Oxford · GBOxford Spires Academy · GBScience Oxford · GBUniversity of Birmingham · GBUniversity of East Anglia · GBUNSW Sydney · AU

Funding

British Heart Foundation FS/IPBSRF/22/27060
6 · The paper itself

Abstract

backgroundOlder patients with multimorbidity and polypharmacy have been under-represented in clinical trials. We aimed to assess the effect of different intensities of antihypertensive treatment on changes in blood pressure, major safety outcomes, and patient-reported outcomes in this population.

methodsATEMPT was a decentralised, two-armed, parallel-group, open-label randomised controlled pilot trial conducted in the Thames Valley area, South East England. Individuals aged 65 years or older with multimorbidity (three or more chronic conditions) or polypharmacy (five or more types of medications) and a systolic blood pressure of 115-165 mm Hg were eligible for inclusion. Participants were identified through a search of national hospital discharge databases, identification of patients registered with an online pharmacy, and via targeted advertising on social media platforms. Participants were randomly assigned to receive up to two more classes versus up to two fewer classes of antihypertensive medications. Apart from routine home visits for conducting the baseline assessment, all communication, monitoring, and management of participants by the trial team was conducted remotely. The primary outcome was change in home-measured blood pressure.

findingsBetween Dec 15, 2020, and Aug 31, 2022, 230 participants were randomly assigned (n=126 to more vs n=104 to fewer antihypertensive medications). The frequency of serious adverse events was similar across both groups; no cardiovascular events occurred in the more antihypertensive drugs group, compared with six in the fewer antihypertensive drugs group, of which two were fatal. Over a 13-month follow-up period, the mean systolic blood pressure in the group allocated to receive more antihypertensive medications decreased from 134·5 mm Hg (SD 10·7) at baseline to 122·1 mm Hg (10·5). By contrast, in the group allocated to receive fewer antihypertensive medications, it remained relatively unchanged, moving from 134·8 mm Hg (SD 11·2) at baseline to 132·9 mm Hg (15·3); this corresponded to a mean difference of -10·7 mm Hg (95% CI -17·5 to -4·0).

interpretationRemotely delivered antihypertensive treatment substantially reduced systolic blood pressure in older adults who are often less represented in trials, with no increase in the risk of serious adverse events. The results of this trial will inform a larger clinical trial focusing on assessing major cardiovascular events, safety, physical functioning, and cognitive function that is currently in the planning stages. These results also underscore the efficiency of decentralised trial designs, which might be of broader interest in other settings.

fundingNational Institute for Health Research Oxford Biomedical Research Centre and the Oxford Martin School.

Indexed as

Antihypertensive AgentsHypertensionAgedHumansMultimorbidityPilot ProjectsPolypharmacyAntihypertensive Agents

Identifiers

PMID38342123
PMCPMC11649844
OpenAlexW4391872952

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.