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Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies
  1. Alexandros Briasoulis1,
  2. Vikram Agarwal2,
  3. Dimitris Tousoulis3,
  4. Christodoulos Stefanadis3
  1. 1Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, Illinois, USA
  2. 2Department of Cardiology, St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
  3. 31st Cardiology Unit, Athens University Medical School, Athens, Greece
  1. Correspondence to Dr Alexandros Briasoulis, Department of Medicine, ASH Comprehensive Hypertension Center, University of Chicago Medicine, 5841 S. Maryland Ave MC 1027, Chicago, IL 60637, USA; alexbriasoulis{at}gmail.com

Abstract

Context Despite the high incidence of hypertension, the elderly population is not represented in clinical trials as they have upper age limits or do not present age-specific results.

Objectives The present study was designed to systematically review prospective randomized trials and assess the effects of antihypertensive treatment on cardiovascular, all-cause mortality, stroke and heart failure in patients over 65 years of age.

Data Sources We systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE and Cochrane for prospective randomized studies (1970–2012) in which patients were randomized either to antihypertensive treatment and non-drug control group or to different antihypertensive treatments.

Study selection We identified 18 clinical studies, with 19 control arms and 19 treatment arms examining 59285 controls, 55569 hypertensive patients with an average follow up duration of 3.44 years. The mean age of patients on treatment was 71.04 years.

Data Extraction Included studies were divided and analyzed in 2 subgroups: i) studies comparing treatment group vs non-drug placebo group with a BP decrease of 27.3/11.1 mmHg and ii) studies comparing two anti-hypertensive regimens with baseline BP ∼157/86, and BP reduction to less than 140/80.

Results A significant reduction in all four outcomes was found in the first group of studies. In the second group similar BP reduction resulted in equivalent risk reduction in both treatment groups. In the meta-regression analysis mean SBP difference was linearly associated with all-cause, cardiovascular, stroke and heart failure risk reduction.

Conclusion Reducing BP to a level of 150/80 mmHg is associated with large benefit in stroke, cardiovascular and all-cause mortality as well as heart failure risk in elderly individuals. Different antihypertensive regimens with equal BP reduction have similar effects on cardiovascular outcomes. SBP rather than DBP reduction is significantly related to lower cardiovascular risk in this population.

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