title: Does lowering blood pressure with antihypertensive therapy preserve independence in activities of daily living? A systematic review.
abstract: BACKGROUND
  Hypertension is a major risk factor for functional impairment. Dependence is an important related outcome for older adults, but outcomes in hypertension trials appear to focus primarily on major vascular events. This systematic review had 2 objectives: (i) to determine the proportion of randomized controlled trials (RCTs) evaluating antihypertensive therapies that reported a measure of a person's ability to carry out activities of daily living (ADL) and (ii) to evaluate the effect of blood pressure (BP)-lowering therapies on ability to carry out ADL compared with control therapy.
  
  
  METHODS
  We searched electronic databases, reference lists of relevant meta-analyses, and hypertension guidelines for clinical trials of adults with hypertension/prehypertension that were randomized to antihypertensive therapy or control for ≥1 year.
  
  
  RESULTS
  Of 2,924 citations screened, there were 93 eligible RCTs. One (1%) reported ADL as a primary outcome measure. Nine (10%) reported ADL as a secondary outcome. Of these, 6 used validated ADL scales, whereas 4 measured ADL within quality-of-life scales. Six trials with duration of ≥1 year (n = 12,663) were amenable to meta-analysis, despite use of different ADL scales. The odds of having difficulty with ADL was reduced by BP-lowering therapy compared with control therapy (odds ratio = 0.84; 95% confidence interval = 0.77-0.92; I (2) = 0%).
  
  
  CONCLUSIONS
  We identified few trials of antihypertensive therapy that reported ADL as an outcome measure, with heterogeneity in scales used. Antihypertensive therapy was associated with a lower risk of ADL impairment compared with control therapy. RCTs evaluating the effect of antihypertensive drugs on ADL in older adults with mild hypertension are required.
authors.affiliation: Department of Medicine for Elderly, University Hospital Galway, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; canavanmichelle@gmail.com.
authors.forename: Michelle
authors.initials: M
authors.lastname: Canavan
authors.affiliation: HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; Population Health Research Institute, Hamilton, Ontario, Canada;
authors.forename: Andrew
authors.initials: A
authors.lastname: Smyth
authors.affiliation: Population Health Research Institute, Hamilton, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada;
authors.forename: Jackie
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Sligo Regional Hospital, Sligo, Ireland;
authors.forename: Mette
authors.initials: M
authors.lastname: Jensen
authors.affiliation: HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Emer R
authors.initials: ER
authors.lastname: McGrath
authors.affiliation: Department of Medicine for Elderly, University Hospital Galway, Galway, Ireland;
authors.forename: Eamon C
authors.initials: EC
authors.lastname: Mulkerrin
authors.affiliation: Department of Medicine for Elderly, University Hospital Galway, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; Population Health Research Institute, Hamilton, Ontario, Canada;
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Donnell
mesh_terms: D000203:Activities of Daily Living; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: activities of daily living; antihypertensive therapy; blood pressure; functional impairment; hypertension; older adults.