Treatment of arterial hypertension in the very elderly: a meta-analysis of clinical trials

Abstract

The benefits of lowering blood pressure are obvious for the population up to the age of 65 years, but whether and, if so, which treatment is beneficial in the very elderly population remains still a matter of debate. We conducted a meta-analysis of randomised controlled clinical trials with duration of at least 12 months and the analysis of cardio- and cerebrovascular endpoints in participants aged 75 years and over. MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials) and the WHO-ISH Collaboration register were searched until October 20, 2009. Further, references from reviews, trials and previously published meta-analyses were analysed. A total of 10 studies were included providing morbidity and mortality data with a total of 8667 participants in the meta-analysis, with separate analyses for studies on isolated systolic hypertension. There were 148 non-fatal strokes and 287 cardiovascular morbidity and mortality events among treated patients, compared with 176 non-fatal strokes (p = 0.02) and 366 cardiovascular morbidity and mortality events (p = 0.0001) among control patients. Rates of heart failure were significantly reduced (64 vs. 121 events; p = 0.00001), total mortality remained unchanged (odds ratio 0.97). Further, 9 studies with 6933 participants were included in the systematic review of blood pressure reduction trials. The average blood pressure achieved at the end of the studies was 164/83 mmHg in the placebo group and 150/83 mmHg in the treatment group. At the beginning of the study blood pressure was 170.6/ 88.6 mmHg in the placebo group and 175.4/94.6 mmHg in the treatment group. Changes were only significant for systolic blood pressure in the treatment group (p = 0.0008). Treating healthy subjects aged 75 years and older with moderate to severe hypertension reduces non-fatal strokes, cardiovascular morbidity and mortality and the incidence of heart failure but does not change total mortality.

Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population

“…42 Also, in a similar meta-analysis of 10 RCTs (total n: 8,667) recruiting hypertensive patients aged ≥75 years, antihypertensive medications did not yield any significantly reduced all-cause mortality. 43 However, both meta-analyses showed that treatment decreased CV events, stroke, and heart failure. 42,43 Although evidence supporting the hypertension paradox is not as vigorous as the support around obesity or cholesterol paradoxes, the latest Evidence-Based Guideline for the Management of High Blood Pressure in Adults recommended a 10-point higher SBP (150 mmHg instead of the traditional 140) as the goal of treatment among adults aged ≥60 years; in addition, the guideline did not make any recommendation for a BP goal among people aged ≥70 years with moderately to severely reduced kidney function (GFR <60 mL/min/1.73 m 2 ).…”

Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

“…Meta-analysis of clinical trials showed that treatment of hypertension in older adults is as beneficial as that in younger adults [11, 12]. It is well established now that the treatment of hypertension in elderly patient was associated with a reduction in the rate of fatal or nonfatal stroke, a reduction in the rate of death from stroke, a reduction in the rate of death from any cause, a reduction in the rate of death from cardiovascular causes, and a reduction in the rate of heart failure [12, 13]. …”

Relationship between resistant hypertension and&nbsp;arterial stiffness assessed&nbsp;by brachial-ankle pulse wave velocity in the older patient

“…Another large-scale meta-analysis demonstrated the relevance of BP to cardiovascular mortality in the population aged 40–89 years, but the contribution of high BP to cardiovascular mortality decreases with advancing age 16. Further, a 2011 meta-analysis of randomized controlled trials in hypertensive patients aged 75 years and older concluded that treatment reduced cardiovascular morbidity and mortality rates and the incidence of heart failure, even though the total mortality rate was not affected 17. Opinion on treating the very elderly (≥80 years) was divided until the results of the Hypertension in the Very Elderly Trial18 were published in 2008.…”