Hypertension in the Elderly

Alexandros Briasoulis, MD,
December 11, 2013

We read with interest the correspondence of Luis Carlos Saiz regarding our meta-analysis on the effects of antihypertensive treatment in patients over 65 years of age. The author asserts the INternational VErapamil SR-Trandolapril STudy (INVEST) trial [1] should not have been included in the meta-analysis as it did not recruit a predominantly elderly population.

INVEST enrolled a total of 22,576 patients from 862 sites with the majority of patients being women (52%) with a mean age of 66 years (in our analysis one of the inclusion criteria is mean age of 65 years or above). Approximately one third of patients were older than 70 years and more than 2,000 patients were >85 years old, making this one of the largest randomized subgroups to be reported among older patients. Therefore, it was reviewed and included in the ACCF/AHA 2011 expert consensus document on hypertension in the elderly [2].

Secondary analysis from INVEST trial showed that for patients more than 70 years old higher systolic blood pressure was associated with less risk for death, myocardial infarction, or stroke then SBP lower than 130 mmHg [3]. These findings are in accordance with the results of our sensitivity analysis for patients 70 years old or older, which did not include the INVEST study. Additionally, the J-curve association between blood pressure and primary outcomes was similar for those above and below the age of 65 [4].

We would agree with the author that more data from studies on exclusively elderly population are required. However, we believe that the currently available evidence is against author's assertion that the INVEST trial should have been excluded from the analysis.

References

1. Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil- Trandolapril Study (INVEST): a randomized controlled trial. JAMA. 2003;290(21):2805-16.

2. Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2011;123:2434-2506.

3. Denardo SJ, Gong Y, Nichols WW, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an international verapamil ST-Trandolapril (INVEST) substudy. Am J Med. 18 2010;123:719-26.

4. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med. 2006;144:884-93.

Conflict of Interest:

None declared

Conflict of Interest

None declared