Evidence map›Paper›PMID 39094592›Full record

Trial reportThe lancet. Healthy longevity2024

Effect of antihypertensive deprescribing on hospitalisation and mortality: long-term follow-up of the OPTiMISE randomised controlled trial.

James P Sheppard, Eleanor Temple, Ariel Wang, Anne Smith, Stephanie Pollock, Gary A Ford, F D Richard Hobbs, Nicola Kenealy, Paul Little, Mark Lown and 8 more

Abstract 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 15 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing 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

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

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Observational
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  9. Review
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  13. Review
  14. Article
  15. Challenging the status quo: deprescribing antihypertensive medication in older adults in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

James P SheppardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Electronic address: james.sheppard@phc.ox.ac.uk.
Eleanor TempleNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ariel WangNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Anne SmithNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Stephanie PollockNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Gary A FordRadcliffe Department of Medicine, University of Oxford, UK and Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nicola KenealyNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Paul LittlePrimary Care Research Group, University of Southampton, Southampton, UK.
Mark LownPrimary Care Research Group, University of Southampton, Southampton, UK.
Simon de LusignanNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Jonathan MantPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
David McCartneyNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Rupert A PayneHealth and Community Sciences, University of Exeter, Exeter, 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.
OPTiMISE Investigators

Funding

British Heart Foundation PG/21/10341
6 · The paper itself

Abstract

backgroundDeprescribing of antihypertensive medications is recommended for some older patients with low blood pressure and frailty. The OPTiMISE trial showed that this deprescribing can be achieved with no differences in blood pressure control at 3 months compared with usual care. We aimed to examine effects of deprescribing on longer-term hospitalisation and mortality.

methodsThis randomised controlled trial enrolled participants from 69 general practices across central and southern England. Participants aged 80 years or older, with systolic blood pressure less than 150 mm Hg and who were receiving two or more antihypertensive medications, were randomly assigned (1:1) to antihypertensive medication reduction (removal of one antihypertensive) or usual care. General practitioners and participants were aware of the treatment allocation following randomisation but individuals responsible for analysing the data were masked to the treatment allocation throughout the study. Participants were followed up via their primary and secondary care electronic health records at least 3 years after randomisation. The primary outcome was time to all-cause hospitalisation or mortality. Intention-to-treat analyses were done using Cox regression modelling. A per-protocol analysis of the primary outcome was also done, excluding participants from the intervention group who did not reduce treatment or who had medication reinstated during the initial trial 12-week follow-up period. This study is registered with the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT2016-004236-38) and the ISRCTN Registry (ISRCTN97503221).

findingsBetween March 20, 2017, and Sept 30, 2018, a total of 569 participants were randomly assigned. Of these, 564 (99%; intervention=280; control=284) were followed up for a median of 4·0 years (IQR 3·7-4·3). Participants had a mean age of 84·8 years (SD 3·4) at baseline and 273 (48%) were women. Medication reduction was sustained in 109 participants at follow-up (51% of the 213 participants alive in the intervention group). Participants in the intervention group had a larger reduction in antihypertensives than the control group (adjusted mean difference -0·35 drugs [95% CI -0·52 to -0·18]). Overall, 202 (72%) participants in the intervention group and 218 (77%) participants in the control group experienced hospitalisation or mortality during follow-up (adjusted hazard ratio [aHR] 0·93 [95% CI 0·76 to 1·12]). There was some evidence that the proportion of participants experiencing the primary outcome in the per-protocol population was lower in the intervention group (aHR 0·80 [0·64 to 1·00]).

interpretationHalf of participants sustained medication reduction with no evidence of an increase in all-cause hospitalisation or mortality. These findings suggest that an antihypertensive deprescribing intervention might be safe for people aged 80 years or older with controlled blood pressure taking two or more antihypertensives.

fundingBritish Heart Foundation and National Institute for Health and Care Research.

Indexed as

Antihypertensive AgentsDeprescriptionsHospitalizationHypertensionAged, 80 and overBlood PressureEnglandFemaleFollow-Up StudiesHumansMaleAntihypertensive Agents

Identifiers

PMID39094592
PMCPMC11327766

What OpenQuestion holds

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LicenceCC BY
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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.