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Table 4 Characteristics of the participants in the included studies

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

Author year Setting / country / ethnicity Male sex Agea Reported comorbidities Reported concomitant medications Functional status/Frailty level Cognitive status
Carlsson 2014 [43] Sweden 50.14% Men: mean age 72.3 years, 79% ≥ 65 years.
Woman: mean age 77.2 years, 92%
≥ 65 years
Diagnosis of both AF and hypertension (inclusion criteria),
coronary heart disease, cerebrovascular diseases, including intracranial bleeding and peripheral embolism, congestive heart failure, DM II
- Diuretic drugs (thiazides, related agents, combined formulations with other drugs, loop diuretics, potassium-saving diuretics)
- Beta blocker (ß1-selective, non-selective)
- Calcium receptor-blocking agents (vessel-selective, heart-selective)
- RAS-Blockers (ACE-inhibitors, ARBs)
- Lipid-lowering drugs (statins)
- antithrombotic drugs
Not reported Not reported
Collier 2011 [44] UK, Sweden,
Denmark, Iceland, Norway, and Finland
Patients ≥65
Amlodipine-based regimen
73.6%
Atenolol-based regimen
73.5%
Patients ≥65
Amlodipine-based regimen
71.1 (4.0)
Atenolol-based regimen
71.1 (4.0)
Type 2 diabetes mellitus, ECG abnormalities (not LVH), LVH (on ECG or ECHO), Peripheral vascular disease No previous antihypertensive use, n (%):
Amlodipine-based regimen
681 (16.8)
Atenolol-based regimen
677 (16.5)
Aspirin use, n (%):
Amlodipine-based regimen
1066 (26.4)
Atenolol-based regimen
1046 (25.5)
Not reported Not reported
Coope 1986 [37] 13 general practices in England and Wales Intervention group: 29.0%
Control group: 32.0%
Intervention group: 68.7 (5.2) years
Control group: 68.8 (5.1) years
Intervention group
Left ventricular hypertrophy on ECG: n = 8
Cardiac enlargement on chest XRay: n = 22
Control group
Left ventricular hypertrophy on ECG: n = 11
Cardiac enlargement on chest XRay: n = 21
Not stated Not stated Not stated
Subgroup analysis in Coope 1986 [37] See above 29.1%
(based on own calculations)
70–79 years Not stated See above See above See above
Gelber 2013 [45] Hawaii, USA (Japanese men) 100% Overall mean age: 77
No drug 77.2 (4.2)
BB alone 76.2 (3.8)
ACE alone 76.7 (4.1)
Diuretic alone 77.4 (4.0)
CCB alone 76.9 (4.0)
Vasodilators alone 76.8 (3.6)
BB & 1 other 76.5 (3.6)
Other drug combi-nation 77.0 (4.0)
Type 2 diabetes mellitus, CVD (defined as history of myocardial infarction, angina and other coronary heart disease or stroke), APOE Not reported Not reported BB use was not significantly associated with a
lower risk of cognitive impairment, suggesting that
medication class may be less relevant if the SBP is not adequately controlled.
Pepine 2003 [34] 862 primary care sites in 14 countries worldwide
Calcium antagonist group (%):
White 48.5
Hispanic 35.7
Black 13.4
Asian 0.6
Other/multiracial 1.9
Non-calcium antagonist group (%):
White 48.3
Hispanic 35.6
Black 35.6
Asian 0.8
Other/multiracial 1.9
Calcium antagonist group (%): 48.1
Non-calcium antagonist group (%): 47.7
Calcium antagonist group: 66,0 (9.7) years
Non-calcium antagonist group: 66,1 (9.8) years
Calcium antagonist group (%):
Myocardial infarction 32.1
Prior myocardial infarction or abnormal angiogram 52.6
Angina pectoris 66.2
CABG ≥1 month ago 15.5
PCI ≥ 1 month ago 15.2
CABG or PCI 27.3
Stroke 5.3
Left ventricular hypertrophy 21.5
Unstable angina ≥1 month ago 11.4
Arrhythmia 7.1
Heart failure class II-III 5.5
Peripheral vascular disease 11.9
Diabetes 28.1
Hypercholesterolemia 55.9
Renal impairment 1.9
Cancer 3.5
Non-calcium antagonist group (%):
Myocardial infarction 31.8
Prior myocardial infarction or abnormal angiogram 53.3
Angina pectoris 67
CABG ≥1 month ago 16.1
PCI ≥ 1 month ago 14.7
CABG or PCI 27.3
Stroke 5.0
Left ventricular hypertrophy 22.3
Unstable angina ≥1 month ago 11.5 Arrhythmia 7.1
Calcium antagonist group (%):
Aspirin© or other antiplatelet inhibitors 57
NSAIDsb 17.6
Antidiabetic medication 22.1
Any lipid-lowering agent 36.8
Nitrates 35.4
Potassium supplement 6.9
Hormone replacement 17.7
Non-calcium antagonist group:
Aspirin© or other antiplatelet inhibitors:
56.4
NSAIDs: 17.9
Antidiabetic medication: 22.9
Any lipid-lowering agent: 36.6
Nitrates: 36.6
Potassium supplement 6.9
Hormone replacement 18.5
Not stated Not stated
     Heart failure class II-III 5.6
Peripheral vascular disease 12.0
Diabetes 28.6
Hypercholesterolemia 55.6
Renal impairment 1.9
Cancer 3.3
   
Subgroup analysis in Pepine 2003 [34] Not stated Not stated >70 years Not stated Not stated Not stated Not stated
Ruwald 2012 [40] Denmark, Finland, Iceland, Norway, Sweden, and UK, 45–66 years:
losartan: 51.2%
atenolol: 50.6%
67–83 years:
losartan: 41.3%
atenolol: 42.0%
overall mean age 67 years
46.8% <66 years
53.2% ≥67 years
Any vascular disease: 25% (Coronary heart disease 16%, cerebrovascular disease 8%, peripheral vascular disease 6%), atrial fibrillation: 4%
diabetes: 13%
isolated systolic hypertension:
14%
Not reported Not reported Not reported
Testa 2014 [46] Campania/Southern Italy 41% Mean age 74.4 (±6.4)
93% ≥ 65 y.
Hypertension (inclusion criteria)
Diabetes, chronic renal failure, AF
ACE-inhibitors, diuretics, hypolipidemic drugs BADL (basic activities of daily living)
GDS (geriatric depression scale)
MMSE:
Atenolol vs. no Atenolol 24.9 vs. 25.1 (p = 0.841)
Studies based on the COPE (Combination Therapy of Hypertension to Prevent Cardiovascular Events) trial
Author year Setting / country / ethnicity Male sex Age Reported comorbidities Reported concomitant medications Functional status/Frailty level Cognitive status
COPE trial
Matsuzaki [47]
Main trial
Japan Overall:
benidipine plus
-ARB: 51%
-BB: 50.5%
-TD: 50.5%
Benidipine plus
-ARB: 63.0 (10.6)
-BB: 63.2 (10.8)
-TD: 63.1 (10.8)
ARB/BB/TD groups:
Overall:
previous casdiovascular disease: 13%/11.4%/12.5%
Arrhythmia: 2.7%/3.0%/2.4%
Diabetes: 13.9%/14.2%/14.4%
ARB/BB/TD groups:
Overall:
Antiplatelet agents: 8.9%/6.8%/7.3%
Lipid-lowering agents: 21.1%/20.4%/21.2%
Antidiabetic agents: 6.9%/7.3%/7.2%
Not reported Not reported
Ogihara [41]   ≥65 years:
-ARB: 43.6%
-BB: 43.8%
-TD: 42.3%
46.6% aged ≥65 years (≥65 years: mean age 72.6 years) ≥65 years:
previous cardiovascular disease: 18.3%
stroke: 4.4%
angina pectoris: 4.8%
MI: 1.05/0.7%/1.2%
Arrhythmia: 3.6%/3.9%/3.6%
Diabetes: 16.5%/16.5%/16.8%
≥65 years:
Antiplatelet agents: 13.7%/10.7%/11.8%
Lipid-lowering agents: 23.1%/21.7%/20.4%
Antidiabetic agents: 8.6%/9.2%/9.0%
  
Studies based on the Medical Research Council (MRC) trial
Author year Setting / country / ethnicity Male sex Age Reported comorbidities Reported concomitant medications Functional status/Frailty level Cognitive status
MRC 1992 [35]
Main trial
226 general practices in England, Scotland, and Wales Diuretic 42.0%
Beta blocker 41,0%
Placebo 42,0%
Range 65–74 years. Not stated Not stated Not stated Not stated
Bird 1990 [36] see above 41.0% Mean (SD) 70.3 (2.7) years see above see above see above see above
Carr 2012 [42] see above 42% Mean age 70.3 years
Placebo 70.3
Diuretic 70.3
b-blocker 70.4
see above see above see above see above
Lever 1992 [48] see above see above see above see above see above see above see above
Lever 1993 [39] see above see above see above see above see above see above see above
  1. Legend: CABG coronary artery bypass graft, PCI percutaneous coronary interventions, SD standard deviation, a Mean age (SD) years, b Non Steroid Anti Inflammatory Drugs, APOE Apolipoprotein E, ARB angiotensin-receptor blocker, BB beta-blocker, CVD cardiovascular disease, MI Myocardial infarction, GDS Geriatric Depression Scale, TD: thiazide diuretic