Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults

Aubert, Carole Elodie; Sussman, Jeremy B.; Hofer, Timothy P.; Cushman, William C.; Ha, Jae Jung; Min, Lillian

doi:10.7326/m21-1456

Cited by 8 publications

(13 citation statements)

References 21 publications

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“…We retrieved 3133 unique records, of which 200 were included in the review (Figure 1). All reasons for excluding records after full-text review are given in eAppendix 6 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“… The included studies spanned 26 fields of medicine, predominately infectious disease (43 [22%]; 27 [14%] on COVID-19), cardiology (30 [15%]), and oncology (30 [15%]) . One hundred and thirty-one studies (66%)…”

Section: Resultsmentioning

confidence: 99%

“…One-hundred and fifteen studies (58%) completely reported how the target trial protocol was emulated. Eighty-seven studies (44%) provided both the protocol of the target trial and described how it was emulated (Table 2).…”

Section: Resultsmentioning

confidence: 99%

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Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Hansford,

Cashin,

Jones

et al. 2023

JAMA Netw Open

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ImportanceObservational (nonexperimental) studies that aim to emulate a randomized trial (ie, the target trial) are increasingly informing medical and policy decision-making, but it is unclear how these studies are reported in the literature. Consistent reporting is essential for quality appraisal, evidence synthesis, and translation of evidence to policy and practice.ObjectiveTo assess the reporting of observational studies that explicitly aimed to emulate a target trial.Evidence ReviewWe searched Medline, Embase, PsycINFO, and Web of Science for observational studies published between March 2012 and October 2022 that explicitly aimed to emulate a target trial of a health or medical intervention. Two reviewers double-screened and -extracted data on study characteristics, key predefined components of the target trial protocol and its emulation (eligibility criteria, treatment strategies, treatment assignment, outcome[s], follow-up, causal contrast[s], and analysis plan), and other items related to the target trial emulation.FindingsA total of 200 studies that explicitly aimed to emulate a target trial were included. These studies included 26 subfields of medicine, and 168 (84%) were published from January 2020 to October 2022. The aim to emulate a target trial was explicit in 70 study titles (35%). Forty-three studies (22%) reported use of a published reporting guideline (eg, Strengthening the Reporting of Observational Studies in Epidemiology). Eighty-five studies (43%) did not describe all key items of how the target trial was emulated and 113 (57%) did not describe the protocol of the target trial and its emulation.Conclusion and RelevanceIn this systematic review of 200 studies that explicitly aimed to emulate a target trial, reporting of how the target trial was emulated was inconsistent. A reporting guideline for studies explicitly aiming to emulate a target trial may improve the reporting of the target trial protocols and other aspects of these emulation attempts.

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“…We retrieved 3133 unique records, of which 200 were included in the review (Figure 1). All reasons for excluding records after full-text review are given in eAppendix 6 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Hansford,

Cashin,

Jones

et al. 2023

JAMA Netw Open

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“…Hypertension was defined as a previous definitive diagnosis that referred to systolic blood pressure (SBP) of ≥140 mm Hg and/or a diastolic blood pressure (DBP) of ≥90 mm Hg on at least three resting measurements at no fewer than two separate health care visits according to the American Heart Association (AHA) recommendations. 15 Diabetes was defined as a previous definitive diagnosis that referred to fasting plasma glucose (FPG) ≥ 7.0 mmol/L or two-hour postprandial glucose (2-h PG) ≥ 11.1 mmol/L during an oral glucose tolerance test (OGTT) according to the American Diabetes Association (ADA) recommendations. 16 MACEs were defined as cardiac death, heart failure, bleeding events and readmission.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Nutritional Index as a Novel Predictor of Long-Term Prognosis in Patients with Coronary Artery Disease After Percutaneous Coronary Intervention

Liu

Zheng

Tang

et al. 2022

Clin Appl Thromb Hemost

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Background The Prognostic Nutritional Index (PNI) has been reported to be correlated with long-term outcomes after gastrointestinal tumor surgery. However, to our knowledge, only a few studies have shown that the PNI is related to cardiovascular diseases. Therefore, we aimed to assess the association between the PNI and long-term outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Methods This was retrospective observational study. A total of 3561 patients with CAD after PCI were retrospectively enrolled in the CORFCHD-ZZ study from January 2013 to December 2017. The patients (3519) were divided into three groups according to PNI tertiles: the first tertile (PNI < 47.12, n = 1173), the second tertile (47.12 ≤ PNI < 51.50, n = 1185), and the third tertile (PNI ≥ 51.50, n = 1161). The mean follow-up time was 37.59 ± 22.24 months. The primary endpoint long-term mortality, including all-cause mortality (ACM) and cardiac mortality (CM).Secondary endpoints were major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs). Result In our study, the incidences of ACM in the first, second, and third tertiles were 3.8%, 1.8% and 1.4%, respectively ( P < 0.001). The incidences of CM occurring in the first, second, and third tertiles were 1.7%, 3.1% and 2.1%, respectively ( P < 0.001).There was statistically significant different in primary endpoints incidence. MACEs occurred in 139 patients (11.8%) in the first tertile, 121 patients(11.1%) in the second tertile and 123 patients(10.8%) in the third tertile( P = 0.691). MACCEs occurred in 183 patients (15.6%) in the first tertile, 174 patients(14.7%) in the second tertile and 160 patients(13.85%) in the third tertile( P = 0.463).There was no statistically significant different in secondary endpoints incidence. Kaplan–Meier analyses showed that elevated PNI was significantly related to long-term CM (log rank, P < 0.001) and long-term ACM (log-rank, P < 0.001). Cox regression analyses suggested that compared with the patients in the first tertile, the risk of ACM was decreased to 60.9% (HR = 0.609, 95% CI: 0.398–0.932, P = 0.029) in the second tertile and 40.3%(HR = 0.403, 95% CI: 0.279–0.766, P = 0.003) in the third tertile, while the risk of CM was decreased to 58.8%(HR = 0.588, 95% CI: 0.321–0.969, P = 0.038) in the second tertile and 46.6%(HR = 0.466, 95% CI: 0.250–0.870, P = 0.017) in the third tertile. Multivariate Cox regression analyses showed that the PNI was an independent predictor of long-term ACM and CM. Conclusion Our finding shown that PNI is an independent predictor in CAD patients after PCI，the higher the PNI, the less occurring adverse event. Therefore，PNI may be an new biomarker to predict long-term outcome of CAD patients after PCI.

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“…These studies encompass several key areas of hypertension research: optimal hypertension targets in older adults [3 ▪▪ ], the safety and effectiveness of potassium-based salt substitution [4,5 ▪▪ ], the use of thiazide-like diuretics in advanced chronic kidney disease [6 ▪▪ ] and under- recognition of primary aldosteronism [7 ▪ ,8]. We will also summarize evolving global trends in hypertension [9 ▪ ], evidence examining strategies for intensification of antihypertensive treatment in older patients [10] and use of cuffless blood pressure devices [11,12]. Each of the selected studies brings forward innovative ideas in approaching hypertension management and lays the groundwork for future research to further optimize our approach to hypertension management…”

Section: Introductionmentioning

confidence: 99%

Updates in hypertension: new trials, targets and ways of measuring blood pressure

Salman

Cohen

2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewSeveral recent trials and observational studies have identified critical areas that can help to improve the management and measurement of blood pressure in patients with hypertension. Recent findingsHigh-quality trial evidence supports intensive SBP lowering to 110--130 mmHg in older patients, potassiumbased salt substitution in patients without chronic kidney disease, and chlorthalidone for the management of hypertension in patients with chronic kidney disease. In addition, population-based studies indicate enormous underdiagnosis of primary aldosteronism as well as greater sustained intensification of antihypertensive therapy in older patients by maximizing medication dosage rather than adding new agents. The prevalence of hypertension is stable worldwide, though is generally improving in high-income countries and worsening in low-income countries. Furthermore, although cuffless blood pressure devices have the potential to improve access to blood pressure measurement, they have not yet demonstrated sufficient accuracy for clinical use.

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Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults

Cited by 8 publications

References 21 publications

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Prognostic Nutritional Index as a Novel Predictor of Long-Term Prognosis in Patients with Coronary Artery Disease After Percutaneous Coronary Intervention

Updates in hypertension: new trials, targets and ways of measuring blood pressure

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