Trial reportAmerican journal of hypertension2022
Effects of Antihypertensive Deprescribing Strategies on Blood Pressure, Adverse Events, and Orthostatic Symptoms in Older Adults: Results From TONE.
Trial report in American journal of hypertension, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00000535 (Trial of Nonpharmacologic Interventions in Elderly), which is not on this map. Cited by 11 papers, 2 of them syntheses that pooled 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.
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.
Trial of Nonpharmacologic Interventions in Elderly (TONE)
Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Withdrawal of antihypertensive drugs in older people.The Cochrane database of systematic reviews · 2025Pooled it
- Cardiovascular Disorders and Falls Among Older Adults: A Systematic Review and Meta-Analysis.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Pooled it
- Desprescribing antihypertensives in older people in primary care: subgroup analysis of the MINOR randomised clinical trial.International journal of clinical pharmacy · 2025Trial
- Timing of Orthostatic Blood Pressure Changes and Its Association With Orthostatic Symptoms and Falls at Very Old Ages: Findings From the ARIC Study.Hypertension (Dallas, Tex. : 1979) · 2026Article
- Mechanistic Pathways Linking Type 2 Diabetes Mellitus, Hypertension, and Osteoarthritis to Falls in Older Adults: A Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- Misconceptions and Facts About Orthostatic Hypotension.The American journal of medicine · 2025Review
- Hypertension and orthostatic hypotension in the elderly: a challenging balance.The Lancet regional health. Europe · 2025Review
- Intensive antihypertensive treatment does not lower cerebral blood flow or cause orthostatic hypotension in frail older adults.GeroScience · 2024Observational
- Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association.Hypertension (Dallas, Tex. : 1979) · 2024Review
- Orthostatic Hypotension in Hypertensive Adults: Harry Goldblatt Award for Early Career Investigators 2021.Hypertension (Dallas, Tex. : 1979) · 2022Review
- Antihypertensive Deprescribing in Older Adults: a Practical Guide.Current hypertension reports · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated the efficacy of weight loss and sodium reduction to reduce hypertension medication use in older adults. However, the longer-term effects of drug withdrawal (DW) on blood pressure (BP), adverse events, and orthostatic symptoms were not reported.
methodsTONE enrolled adults, ages 60-80 years, receiving treatment with a single antihypertensive and systolic BP (SBP)/diastolic BP <145/<85 mm Hg. Participants were randomized to weight loss, sodium reduction, both, or neither (usual care) and followed up to 36 months; ~3 months postrandomization, the antihypertensive was withdrawn and only restored if needed for uncontrolled hypertension. BP and orthostatic symptoms (lightheadedness, feeling faint, imbalance) were assessed at randomization and throughout the study. Two physicians independently adjudicated adverse events, masked to intervention, classifying symptomatic (lightheadedness, dizziness, vertigo), or clinical events (fall, fracture, syncope).
resultsAmong the 975 participants (mean age 66 years, 48% women, 24% black), mean (±SD) BP was 128 ± 9/71 ± 7 mm Hg. Independent of assignment, DW increased SBP by 4.59 mm Hg (95% confidence interval [CI]: 3.89, 5.28) compared with baseline. There were 113 adverse events (84 symptomatic, 29 clinical), primarily during DW. Compared with usual care, combined weight loss and sodium reduction mitigated the effects of DW on BP (β = -4.33 mm Hg; 95% CI: -6.48, -2.17) and reduced orthostatic symptoms long term (odds ratio = 0.62; 95% CI: 0.41, 0.92), without affecting adverse events (hazard ratio = 1.81; 95% CI: 0.90, 3.65). In contrast, sodium reduction alone increased risk of adverse events (hazard ratio = 1.75; 95% CI: 1.04, 2.95), mainly during DW.
conclusionsIn older adults, antihypertensive DW may increase risk of symptomatic adverse events, highlighting the need for caution in withdrawing their antihypertensive medications. CLINICAL TRIALS REGISTRATION: Trial Number NCT00000535.
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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.