Publications
178 results found
Hallgreen CE, Mt-Isa S, Lieftucht A, et al., 2015, Literature review of visual representation of the results of benefit-risk assessments of medicinal products, Pharmacoepidemiology and Drug Safety, Vol: 25, Pages: 238-250, ISSN: 1099-1557
BackgroundThe PROTECT Benefit–Risk group is dedicated to research in methods for continuous benefit–risk monitoring of medicines, including the presentation of the results, with a particular emphasis on graphical methods.MethodsA comprehensive review was performed to identify visuals used for medical risk and benefit–risk communication. The identified visual displays were grouped into visual types, and each visual type was appraised based on five criteria: intended audience, intended message, knowledge required to understand the visual, unintentional messages that may be derived from the visual and missing information that may be needed to understand the visual.ResultsSixty-six examples of visual formats were identified from the literature and classified into 14 visual types. We found that there is not one single visual format that is consistently superior to others for the communication of benefit–risk information. In addition, we found that most of the drawbacks found in the visual formats could be considered general to visual communication, although some appear more relevant to specific formats and should be considered when creating visuals for different audiences depending on the exact message to be communicated.ConclusionWe have arrived at recommendations for the use of visual displays for benefit–risk communication. The recommendation refers to the creation of visuals. We outline four criteria to determine audience–visual compatibility and consider these to be a key task in creating any visual. Next we propose specific visual formats of interest, to be explored further for their ability to address nine different types of benefit–risk analysis information. Copyright © 2015 John Wiley & Sons, Ltd.
Peters R, Collerton J, Granic A, et al., 2015, Antihypertensive drug use and risk of cognitive decline in the very old: an observational study - The Newcastle 85+Study, Journal of Hypertension, Vol: 33, Pages: 2156-2164, ISSN: 1473-5598
Objectives: Older adults are a fast growing group insociety and are at high risk of hypertension, cognitivedecline and dementia. Antihypertensive drugs, particularlycalcium channel blockers (CCB), have been associated witha decreased risk of cognitive decline and dementia. Weused observational data to examine the associationbetween antihypertensive drug class and change incognitive function.Methods: The Newcastle 85R Study is a population-basedcohort study recruiting individuals aged 85 (born in 1921)via general/family practices in Newcastle/North Tyneside,United Kingdom. Data, including blood pressure,antihypertensive drug use and cognitive function [assessedusing the Standardized Mini-Mental State Exam (SMMSE)],were collected at baseline and 3-year follow-up.Results: The study population comprised 238 participantswith a diagnosis of hypertension, prescribedantihypertensive drug treatment and with baseline andfollow-up SMMSE assessment. There was an associationbetween CCB use and less cognitive decline over 3 years(rate of decline was lower by 1.29 SMMSE points (95%confidence interval 0.16–2.42; P ¼ 0.03) compared withthose taking other antihypertensive classes afteradjustment for age, sex, years of education, baselineSMMSE score, smoking, BMI, baseline blood pressure, andincident cerebrovascular event. This finding was evenstronger in the cognitively intact (SMMSE >24), whereinrate of cognitive decline was lower by 1.33 SMMSE points(95% confidence interval 0.30–2.37; P ¼ 0.01), but wasnot seen for other antihypertensive classes.Conclusion: Findings provide support for an associationbetween CCB use and a lower rate of cognitive decline invery old adults with hypertension
Peters R, Peters J, Booth A, et al., 2015, Is air pollution associated with increased risk of cognitive decline? A systematic review, Age and Ageing, Vol: 44, Pages: 755-760, ISSN: 1468-2834
Introduction: exposure to air pollution has been shown to increase risk of inflammatory processes and risk of cardiovascular mortality. Such exposure may therefore also be a risk factor for cognitive impairment/dementia.Method: a systematic review of the literature was conducted with databases searched using keywords for air pollution, cognitive decline and dementia. All identified abstracts and potentially relevant articles were double read. For those papers meeting the inclusion criteria, summary tables were prepared and papers quality assessed.Results: from 1,551 abstracts identified, 10 articles were retrieved of which two were rejected. Of the eight remaining six reported prevalent cognitive assessment with historical pollution exposure and two incident cognitive decline, also with historical pollution exposure. In general, an association was reported between exposure and poorer prevalent measures of cognitive function. Data were mixed for incident cognitive decline with one study finding an association and the other not. Reports were limited by a lack of detailed reporting, use of proxy measures of pollution exposure and a lack of clarity regarding cognitive testing methodology and analysis.Conclusion: this systematic review highlights that there is some evidence of a potential association between air pollution and subsequent cognitive decline. Further work is clearly required and longitudinal analysis of ongoing cohort studies or new research would add much needed clarity to this area.
Peters J, Booth A, Peters R, 2015, Potential for specific dihydropyridine calcium channel blockers to have a positive impact on cognitive function in humans: a systematic review, Therapeutic Advances in Chronic Disease, Vol: 6, Pages: 160-169, ISSN: 2040-6223
Background: There is some evidence to suggest a possible association between calcium channel blocker (CCB) use and a lower decline in cognitive function compared with use of other hypertensive treatments. In particular, there is an emerging interest in the potential for specific CCBs, particularly the dihydropyridine CCBs nitrendipine, nicardipine, cilnidipine, lercandipine, nimodipine, azelnidipine and nilvadipine. The aim of this review was to assess the evidence relating to these specific CCBs and incident cognitive decline or dementia in humans.Methods: A systematic review of the literature was carried out. The databases MEDLINE, Embase and PsychINFO were searched from 1980 to 18 April 2014. All abstracts were reviewed by two independent reviewers.Results: From 753 unique records, 16 full text articles were examined and three retained. The three articles reported data from two studies. A 12-week double-blind randomized controlled trial of nitrendipine compared with cilazapril and a longer and larger double-blind placebo-controlled trial also of nitrendipine, namely the Systolic Hypertension in Europe trial (SYST-EUR). Nitrendipine was associated with a reduction in incident dementia in the SYST-EUR trial. There was no association seen for cognitive outcomes in the smaller trial.Conclusion: At present there is limited evidence to suggest that nitrendipine may be associated with reduction in incident dementia. This association comes from a single trial and needs to be replicated. Furthermore, there is no high-quality evidence for any of the other potential candidate CCBs.
Warwick J, Falaschetti E, Rockwood K, et al., 2015, No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: An investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over, BMC Medicine, Vol: 13, ISSN: 1741-7015
Background: Treatment for hypertension with antihypertensive medication has been shown to reduce stroke, cardiovascular events, and mortality in older adults, but there is concern that such treatment may not be appropriate in frailer older adults. To investigate whether there is an interaction between effect of treatment for hypertension and frailty in older adults, we calculated the frailty index (FI) for all available participants from the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over, and obtained frailty adjusted estimates of the effect of treatment with antihypertensive medication on risk of stroke, cardiovascular events, and mortality. Methods: Participants in HYVET were randomised 1:1 to active treatment with indapamide sustained release 1.5 mg ± perindopril 2 to 4 mg or to matching placebo. Data relating to blood pressure, comorbidities, cognitive function, depression, and quality of life were collected at entry into the study and at subsequent follow-up visits. The FI was calculated at entry, based on 60 potential deficits. The distribution of FI was similar to that seen in population studies of adults aged 80 years and above (median FI, 0.17; IQR, 0.11-0.24). Cox regression was used to assess the impact of FI at entry to the study on subsequent risk of stroke, total mortality, and cardiovascular events. Models were stratified by region of recruitment and adjusted for sex and age at entry. Extending these models to include a term for a possible interaction between treatment for hypertension and FI provided a formula for the treatment effect as a function of FI. For all three models, the point estimates of the hazard ratios for the treatment effect decreased as FI increased, although to varying degrees and with varying certainty. Results: We found no evidence of an interaction between effect of treatment for hypertension and frailty as me
Peters R, Beckett N, Pereira L, et al., 2015, The clock drawing test, mortality, incident cardiovascular events and dementia, INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Vol: 30, Pages: 416-421, ISSN: 0885-6230
Peters R, Booth A, Peters J, 2014, A systematic review of calcium channel blocker use and cognitive decline/dementia in the elderly, JOURNAL OF HYPERTENSION, Vol: 32, Pages: 1945-1958, ISSN: 0263-6352
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- Citations: 38
Hallgreen CE, van den Ham HA, Mt-Isa S, et al., 2014, Benefit-risk assessment in a post-market setting: a case study integrating real-life experience into benefit-risk methodology, Pharmacoepidemiology and Drug Safety, Vol: 23, Pages: 974-983, ISSN: 1099-1557
Peters R, Beckett N, McCormack T, et al., 2014, Treating hypertension in the very elderly-benefits, risks, and future directions, a focus on the hypertension in the very elderly trial, EUROPEAN HEART JOURNAL, Vol: 35, Pages: 1712-1718, ISSN: 0195-668X
Mt-Isa S, Hallgreen CE, Wang N, et al., 2014, Balancing benefit and risk of medicines: a systematic review and classification of available methodologies, PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Vol: 23, Pages: 667-678, ISSN: 1053-8569
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- Citations: 80
Beckett N, Peters R, Leonetti G, et al., 2014, Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial, JOURNAL OF HYPERTENSION, Vol: 32, Pages: 1478-1487, ISSN: 0263-6352
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- Citations: 27
Peters R, Beckett N, Fagard R, et al., 2013, Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial - HYVET, JOURNAL OF HYPERTENSION, Vol: 31, Pages: 1868-1875, ISSN: 0263-6352
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- Citations: 37
Antikainen RL, Beckett N, Peters R, et al., 2013, Prevalence and covariates of electrocardiographic left ventricular hypertrophy in the Hypertension in the Very Elderly Trial, JOURNAL OF HYPERTENSION, Vol: 31, Pages: 1224-1232, ISSN: 0263-6352
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- Citations: 4
Bulpitt CJ, Beckett N, Peters R, et al., 2013, Response to HYVET Ambulatory Blood Pressure Substudy, HYPERTENSION, Vol: 61, Pages: E43-E43, ISSN: 0194-911X
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- Citations: 2
Peters R, Beckett N, 2013, Atrial fibrillation is associated with an increased risk of cognitive and functional decline., Evid Based Med, Vol: 18
Peters R, Beckett N, Poulter R, et al., 2013, Kidney function in the very elderly with hypertension: data from the hypertension in the very elderly (HYVET) trial, AGE AND AGEING, Vol: 42, Pages: 253-258, ISSN: 0002-0729
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- Citations: 17
Mt-Isa S, Peters R, Phillips LD, et al., 2013, Review of visualisation methods for the representation of benefit-risk assessment of medication: Stage 1 of 2
Bulpitt CJ, Beckett N, Peters R, et al., 2013, Does White Coat Hypertension Require Treatment Over Age 80? Results of the Hypertension in the Very Elderly Trial Ambulatory Blood Pressure Side Project, HYPERTENSION, Vol: 61, Pages: 89-+, ISSN: 0194-911X
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- Citations: 61
Peters R, Wells F, Bulpitt C, et al., 2013, Impact of transiently elevated diastolic pressure on cause of death: 29-year follow-up from the General Practice Hypertension Study Group, JOURNAL OF HYPERTENSION, Vol: 31, Pages: 71-76, ISSN: 0263-6352
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- Citations: 3
Peters R, 2013, Limitations, including the misclassification of former drinkers, ADDICTION RESEARCH & THEORY, Vol: 21, Pages: 196-197, ISSN: 1606-6359
Peters R, Wells F, Bulpitt C, et al., 2012, Impact of transiently elevated diastolic pressure on cause of death-29 year follow-up from the general practice hypertension study group, JOURNAL OF HUMAN HYPERTENSION, Vol: 26, Pages: 629-629, ISSN: 0950-9240
Peters R, 2012, Blood pressure, smoking and alcohol use, association with vascular dementia, Experimental Gerontology
Bulpitt CJ, Beckett N, Peters R, et al., 2012, Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET), Journal of Human Hypertension
Beckett N, Peters R, Tuomilehto J, et al., 2012, Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial, BMJ-BRITISH MEDICAL JOURNAL, Vol: 344, ISSN: 0959-535X
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- Citations: 93
Bulpitt C, Beckett N, Peters R, et al., 2011, Blood pressure control for a 2-year cohort in the Hypertension in the Very Elderly Trial (HYVET), JOURNAL OF HUMAN HYPERTENSION, Vol: 25, Pages: 640-640, ISSN: 0950-9240
Wilson D, Peters R, Ritchie K, et al., 2011, Latest Advances on Interventions that May Prevent, Delay or Ameliorate Dementia., Ther Adv Chronic Dis, Vol: 2, Pages: 161-173, ISSN: 2040-6223
OBJECTIVES: IN THIS PAPER WE AIM TO: (1) identify and review midlife risk factors that may contribute to the development of dementia and that may be amenable to intervention; (2) review advances made in our understanding of the most common cause of dementia, Alzheimer's disease (AD), where current pharmacological studies have aimed to modify the disease course; and (3) explore other interventions that may slow cognitive decline in those with AD. METHODS: A review of the literature was conducted to look for interventions that may modify the risk of incident dementia or that may modify symptom progression in those with diagnosed dementia. RESULTS: (1) Midlife risks identified as amenable to intervention include blood pressure, diabetes, elevated cholesterol, poor psychosocial and lifestyle factors. (2) The leading drugs in development can be grouped by their principal target: anti-amyloid, anti-tau and mitochondrial stability. However to date, there have been no successes in late stage Phase III trials of putative disease-modifying drugs for AD. (3) Once the diagnosis of dementia has been made there is little that can slow the rate of decline. Possible exceptions include the use of exercise and antihypertensive medication with some nootropic medication showing promise in small trials. CONCLUSION: (1) It is clear that there are several risk factors in midlife that may lead to a greater likelihood of developing dementia. However, there is no simple intervention to modify these risks. It seems sensible to conclude from the data that avoiding high blood pressure, controlling cholesterol and diabetes as well as maintaining a healthy diet and lifestyle may lower the risk of developing dementia. (2) The need for better outcome measures in clinical trials is evident and may, in part, explain the numerous failures in late-stage clinical trials of disease-modifying drugs. Improved diagnostic test batteries to reduce population heterogeneity in early intervention studies will be
Peters R, Beckett N, Burch L, et al., 2010, The effect of treatment based on a diuretic (indapamide) ± ACE inhibitor (perindopril) on fractures in the Hypertension in the Very Elderly Trial (HYVET), AGE AND AGEING, Vol: 39, Pages: 609-616, ISSN: 0002-0729
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- Citations: 72
Peters R, Beckett N, Beardmore R, et al., 2010, Modelling Cognitive Decline in the Hypertension in the Very Elderly Trial [HYVET] and Proposed Risk Tables for Population Use, PLOS ONE, Vol: 5, ISSN: 1932-6203
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- Citations: 11
Peters R, Pinto E, Beckett N, et al., 2010, Association of depression with subsequent mortality, cardiovascular morbidity and incident dementia in people aged 80 and over and suffering from hypertension. Data from the Hypertension in the Very Elderly Trial (HYVET)., Age Ageing, Vol: 39, Pages: 439-445
BACKGROUND: depression is common in elderly people and may be associated with increased cardiovascular risk and incident dementia. METHOD: participants in the Hypertension in the Very Elderly Trial (HYVET) completed a depression screening instrument, the Geriatric Depression Score (GDS), at baseline and annually. We examined the association of GDS score with incident stroke, mortality and dementia using Cox proportional hazards models (hazard ratios, HR and 95% confidence intervals, CI) adjusted for treatment group and other potential confounders. RESULTS: 2,656 HYVET participants completed the GDS. The mean follow-up was 2.1 years. A GDS score > or =6 was associated with increased risks of all-cause (HR 1.8, 95% CI 1.4-2.3) and cardiovascular mortality (HR 2.10, 95% CI 1.5-3.0), all stroke (HR 1.8, 95% CI 1.2-2.8) and all cardiovascular events (HR 1.6, 95% CI 1.2-2.1). Risk of incident dementia also tended to be increased (HR 1.28, 95% CI 0.95-1.73). Each additional GDS point at baseline also gave rise to a significantly increased risk of fatal and non-fatal cardiovascular events, all-cause mortality and dementia. CONCLUSION: there was a strong association between baseline depression scores and later fatal and non-fatal cardiovascular endpoints over a mean follow-up of 2 years in a hypertensive very elderly group. The mechanism of this association warrants further study.
Peters R, Pinto E, Beckett N, et al., 2010, Association of depression with subsequent mortality, cardiovascular morbidity and incident dementia in people aged 80 and over and suffering from hypertension. Data from the Hypertension in the Very Elderly Trial (HYVET), AGE AND AGEING, Vol: 39, Pages: 439-445, ISSN: 0002-0729
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- Citations: 40
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