Thiazides in the management of hypertension in older adults - a systematic review

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• dc.contributor.author Sommerauer, Christinaca
• dc.contributor.author Kaushik, Nehaca
• dc.contributor.author Woodham, Adrineca
• dc.contributor.author Renom-Guiteras, Annaca
• dc.contributor.author Martinez, Yolanda V.ca
• dc.contributor.author Reeves, Davidca
• dc.contributor.author Kunnamo, Ilkkaca
• dc.contributor.author Al Qur’an, Thekraiatca
• dc.contributor.author Hübner, Steffenca
• dc.contributor.author Sönnichsen, Andreasca
• dc.date.accessioned 2018-04-17T07:18:10Z
• dc.date.available 2018-04-17T07:18:10Z
• dc.date.issued 2017
• dc.description.abstract BACKGROUND: Thiazides are commonly prescribed to older people for the management of hypertension. The objective of this study was to identify the evidence on the risks and benefits of their use among adults aged ≥65 years and to develop recommendations to reduce potentially inappropriate use. METHODS: Systematic review (SR) of the literature covering six databases. We applied a staged search approach, where each search was undertaken only if the previous one did not yield high quality results. Searches 1 and 2 identified relevant SRs and meta-analyses published up to December 2015 from all databases. Search 3 identified additional individual interventional studies (IS) and observational studies (OS) not identified by the preceding searches. We included all studies evaluating the effect of thiazides on patient-relevant outcomes in the management of hypertension with a sufficient number of participants aged ≥65 years or a subgroup analysis based on age. Two independent reviewers extracted data and carried out quality appraisal. Recommendations were developed using the GRADE methodology. RESULTS: Searches 1 to 3 were performed. We included 34 articles reporting on 12 IS and 4 OS. Mean ages ranged from 59 to 83.8 years. Four studies had performed a subgroup analysis by age. Information on comorbidity, polypharmacy and frailty of the participants was scarce or not available. The IS compared thiazides to placebo or other antihypertensive drugs and evaluated cardiovascular endpoints or all-cause-mortality as primary outcomes. The OS investigated the association between thiazide use and the risk of gout, fractures and adverse effects. Our results suggest that thiazides are efficacious in preventing cardiovascular events for this population group. Low-dose regimens of thiazides may be safer than high-dose (low quality of evidence), and a history of gout may increase the risk of adverse events (low quality of evidence). Three recommendations were developed. CONCLUSIONS: The use of low dose treatment with thiazides for the management of hypertension in adults aged 65 and older seems justified, unless a history of gout is present. The quality of the evidence is low and studies rarely describe characteristics of the participants such as polypharmacy and frailty. Further good quality studies are needed.
• dc.description.sponsorship The PRIMA-eDS study was supported by a grant from the European Commission within the 7th Framework Programme (Grant No. 305388–2). The work of YVM was also supported by a grant from the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre. Publication of this article was funded by the UK National Institute for Health Research School for Primary Care Research, University of Manchester.
• dc.format.mimetype application/pdf
• dc.identifier.citation Sommerauer C, Kaushik N, Woodham A, Renom-Guiteras A, Martinez YV, Reeves D. et al. Thiazides in the management of hypertension in older adults - a systematic review. BMC Geriatr. 2017 Oct 16;17(Suppl 1):228. DOI: 10.1186/s12877-017-0576-3
• dc.identifier.doi http://dx.doi.org/10.1186/s12877-017-0576-3
• dc.identifier.issn 1471-2318
• dc.identifier.uri http://hdl.handle.net/10230/34376
• dc.language.iso eng
• dc.publisher BioMed Centralca
• dc.relation.ispartof BMC Geriatrics. 2017 Oct 16;17(Suppl 1):228
• dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/305388
• dc.rights Copyright © The Author(s). 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Hypertension
• dc.subject.keyword Older adults
• dc.subject.keyword Polypharmacy
• dc.subject.keyword Systematic review
• dc.subject.keyword Thiazides
• dc.subject.other Hipertensió -- Tractament
• dc.subject.other Persones grans
• dc.title Thiazides in the management of hypertension in older adults - a systematic reviewca
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion