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

Overview of attention for article published in BMC Geriatrics, October 2017
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Title
Thiazides in the management of hypertension in older adults – a systematic review
Published in
BMC Geriatrics, October 2017
DOI 10.1186/s12877-017-0576-3
Pubmed ID
Authors

Christina Sommerauer, Neha Kaushik, Adrine Woodham, Anna Renom-Guiteras, Yolanda V Martinez, David Reeves, Ilkka Kunnamo, Thekraiat Al Qur‵an, Steffen Hübner, Andreas Sönnichsen

Abstract

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. 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. 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. 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.

X Demographics

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 105 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 105 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 16 15%
Student > Bachelor 13 12%
Researcher 12 11%
Student > Ph. D. Student 7 7%
Professor > Associate Professor 5 5%
Other 15 14%
Unknown 37 35%
Readers by discipline Count As %
Medicine and Dentistry 27 26%
Pharmacology, Toxicology and Pharmaceutical Science 15 14%
Biochemistry, Genetics and Molecular Biology 5 5%
Nursing and Health Professions 4 4%
Social Sciences 4 4%
Other 10 10%
Unknown 40 38%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 04 January 2018.
All research outputs
#13,572,617
of 23,007,887 outputs
Outputs from BMC Geriatrics
#2,025
of 3,233 outputs
Outputs of similar age
#164,518
of 325,927 outputs
Outputs of similar age from BMC Geriatrics
#41
of 61 outputs
Altmetric has tracked 23,007,887 research outputs across all sources so far. This one is in the 39th percentile – i.e., 39% of other outputs scored the same or lower than it.
So far Altmetric has tracked 3,233 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.5. This one is in the 35th percentile – i.e., 35% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 325,927 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 47th percentile – i.e., 47% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 61 others from the same source and published within six weeks on either side of this one. This one is in the 32nd percentile – i.e., 32% of its contemporaries scored the same or lower than it.