Evidence map›Paper›PMID 33568342›Full record

SynthesisBMJ (Clinical research ed.)2021

Association between antihypertensive treatment and adverse events: systematic review and meta-analysis.

Ali Albasri, Miriam Hattle, Constantinos Koshiaris, Anna Dunnigan, Ben Paxton, Sarah Emma Fox, Margaret Smith, Lucinda Archer, Brooke Levis, Rupert A Payne and 10 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 11 pooled it
16.8field-weighted citation impact, top 1% 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

86 citing papers in PubMed, 11 syntheses or guidelines pooled it, 152 citations in OpenAlex.

  1. Pooled it
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  3. Withdrawal of antihypertensive drugs in older people.The Cochrane database of systematic reviews · 2025
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  12. Fluctuations in adherence to antihypertensive medication and cardiovascular outcomes: a secondary analysis of the SPRINT trial.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Trial
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26 more citing papers are in PubMed but not listed here.

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

20 authors at 5 institutions in 1 country.

Ali AlbasriNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.ORCID 0000-0001-7805-1965
Miriam HattleSchool of Medicine, Keele University, Keele, UK.ORCID 0000-0003-1542-6277
Constantinos KoshiarisNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.
Anna DunniganOxford University Hospitals NHS Foundation Trust, Oxford, UK.
Ben PaxtonPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.ORCID 0000-0002-0509-6983
Sarah Emma FoxPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.ORCID 0000-0002-2070-5919
Margaret SmithNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.ORCID 0000-0002-0946-742X
Lucinda ArcherSchool of Medicine, Keele University, Keele, UK.ORCID 0000-0003-2504-2613
Brooke LevisSchool of Medicine, Keele University, Keele, UK.ORCID 0000-0002-4310-3689
Rupert A PayneCentre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK.ORCID 0000-0002-5842-4645
Richard D RileySchool of Medicine, Keele University, Keele, UK.
Nia RobertsBodleian Health Care Libraries, University of Oxford, Oxford, UK.ORCID 0000-0002-1142-6440
Kym I E SnellSchool of Medicine, Keele University, Keele, UK.ORCID 0000-0001-9373-6591
Sarah Lay-FlurrieNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.
Juliet Usher-SmithPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.ORCID 0000-0002-8501-2531
Richard StevensNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.
F D Richard HobbsNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.
Richard J McManusNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK.ORCID 0000-0003-3638-028X
James P SheppardNuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX2 6GG, UK james.sheppard@phc.ox.ac.uk.ORCID 0000-0002-4461-8756
STRATIFY investigators
University of Oxford · GBKeele University · GBUniversity of Cambridge · GBOxford University Hospitals NHS Trust · GBUniversity of Bristol · GB

Funding

Cancer Research UK 21464Department of Health NIHR-RP-02-12-015Medical Research Council MC_UU_00006/6Wellcome Trust
6 · The paper itself

Abstract

objectiveTo examine the association between antihypertensive treatment and specific adverse events.

designSystematic review and meta-analysis. ELIGIBILITY CRITERIA: Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or higher blood pressure targets compared with lower targets. To avoid small early phase trials, studies were required to have at least 650 patient years of follow-up. INFORMATION SOURCES: Searches were conducted in Embase, Medline, CENTRAL, and the Science Citation Index databases from inception until 14 April 2020.

main outcome measuresThe primary outcome was falls during trial follow-up. Secondary outcomes were acute kidney injury, fractures, gout, hyperkalaemia, hypokalaemia, hypotension, and syncope. Additional outcomes related to death and major cardiovascular events were extracted. Risk of bias was assessed using the Cochrane risk of bias tool, and random effects meta-analysis was used to pool rate ratios, odds ratios, and hazard ratios across studies, allowing for between study heterogeneity (τ

resultsOf 15 023 articles screened for inclusion, 58 randomised controlled trials were identified, including 280 638 participants followed up for a median of 3 (interquartile range 2-4) years. Most of the trials (n=40, 69%) had a low risk of bias. Among seven trials reporting data for falls, no evidence was found of an association with antihypertensive treatment (summary risk ratio 1.05, 95% confidence interval 0.89 to 1.24, τ

conclusionsThis meta-analysis found no evidence to suggest that antihypertensive treatment is associated with falls but found evidence of an association with mild (hyperkalaemia, hypotension) and severe adverse events (acute kidney injury, syncope). These data could be used to inform shared decision making between doctors and patients about initiation and continuation of antihypertensive treatment, especially in patients at high risk of harm because of previous adverse events or poor renal function. REGISTRATION: PROSPERO CRD42018116860.

Indexed as

Acute Kidney InjuryAgedAntihypertensive AgentsBlood PressureCausalityGoutHumansHyperkalemiaHypokalemiaMiddle AgedRandomized Controlled Trials as TopicAntihypertensive Agents

Identifiers

PMID33568342
PMCPMC7873715
OpenAlexW3127907964

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.