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

BMC Geriatrics

Systematic Review

Ilkka Kunnamo¹  Christina Sommerauer²  Andreas Sönnichsen²  Steffen Hübner²  Anna Renom-Guiteras³  Thekraiat Al Qur‵an⁴  David Reeves⁵  Yolanda V Martinez⁵  Adrine Woodham⁶  Neha Kaushik⁶ 

[1] Duodecim Medical Publications Ltd, Helsinki, Finland;Institute of General Practice and Family Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany;Institute of General Practice and Family Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany;Department of Geriatrics, University Hospital Parc de Salut Mar, Barcelona, Spain;Institute of General Practice and Family Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany;Department of Public Health, Community Medicine, Jordan University of Science and Technology, Irbid, Jordan;NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England, England;University of Manchester, Centre for Primary Care, Institute of Population Health, Manchester, UK;

关键词: Older adults;    Thiazides;    Hypertension;    Systematic review;    Polypharmacy;   

DOI  :  10.1186/s12877-017-0576-3

来源: Springer

【 摘 要 】

BackgroundThiazides 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.MethodsSystematic 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.ResultsSearches 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.ConclusionsThe 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.

【 授权许可】

CC BY   
© The Author(s). 2017