Evidence mapPaperPMID 29047367Full record

SynthesisBMC geriatrics2017

Effectiveness and safety of beta blockers in the management of hypertension in older adults: a systematic review to help reduce inappropriate prescribing.

Anna Vögele, Tim Johansson, Anna Renom-Guiteras, David Reeves, Anja Rieckert, Lisa Schlender, Anne-Lisa Teichmann, Andreas Sönnichsen, Yolanda V Martinez

Open access · goldAbstract readSystematic Review
In one paragraph

Synthesis in BMC geriatrics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
1.8field-weighted citation impact, top 13% of its field
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

14 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Hallmarks of cardiovascular ageing.Nature reviews. Cardiology · 2023
    Review
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Current problems in burn hypermetabolism.Current problems in surgery · 2020
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 5 countries.

Anna VögeleSouth Tyrolean Academy of General Practice, via dei Vanga, Bolzano, Italy. anna.voegele@sakam.it.
Tim JohanssonInstitute of General Practice and Family Medicine, Paracelsus Medical University, Strubergasse, Salzburg, Austria.
Anna Renom-GuiterasInstitute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.
David ReevesNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Oxford Rd, Manchester, UK.
Anja RieckertInstitute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.
Lisa SchlenderInstitute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.
Anne-Lisa TeichmannInstitute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.
Andreas SönnichsenInstitute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.
Yolanda V MartinezNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Oxford Rd, Manchester, UK.
Witten/Herdecke University · DEManchester Academic Health Science Centre · GBEurac Research · ITParacelsus Medical University · ATParc de Salut · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe benefit from a blood pressure lowering therapy with beta blockers may not outweigh its risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of beta blockers in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project.

methodsSystematic review of the literature using a stage approach with searches for systematic reviews and meta-analyses first, and individual studies only if the previous searches are inconclusive. The target population were older adults (≥65 years old) with hypertension. We included studies reporting on the effectiveness and/or safety of beta blockers on clinically relevant endpoints (e.g. mortality, cardiovascular events, and stroke) in the management of hypertension. The recommendations were developed according to the GRADE methodology.

resultsFifteen studies were included, comprising one meta-analysis, four randomized controlled trials, six secondary analyses of randomized controlled trials and four observational studies. Seven studies involved only older adults and eight studies reported subgroup analyses by age. With regard to a composite endpoint (death, stroke or myocardial infarction) beta blockers were associated with a higher risk of events then were other antihypertensive agents. Further, beta blockers showed no benefit compared to other antihypertensive agents or placebo regarding mortality. They appear to be less effective than other antihypertensive agents in reducing cardiovascular events. Contradictory results were found regarding the effect of beta blockers on stroke. None of the studies explored the effect on quality of life, hospitalisation, functional impairment/status, safety endpoints or renal failure.

conclusionThe quality of current evidence to interpret the benefits of beta blockers in hypertension is rather weak. It cannot be recommended to use beta blockers in older adults as first line agent for hypertension.

Indexed as

Decision Support Systems, ClinicalAdrenergic beta-AntagonistsAgedAntihypertensive AgentsHumansHypertensionInappropriate PrescribingRisk AssessmentAdrenergic beta-AntagonistsAntihypertensive AgentsAgedBeta blockersEffectivenessHypertensionInappropriate prescribingSystematic review

Identifiers

PMID29047367
PMCPMC5647554
OpenAlexW2766788476

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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 Socratic graph.