Pharmacotherapy for hypertension in the elderly
Abstract
Background
Elevated blood pressure (known as hypertension) increases with age, and most rapidly over age 60. Systolic hypertension is more strongly associated with cardiovascular disease than diastolic hypertension, and occurs more commonly in older people. It is important to know the benefits and harms of antihypertensive treatment of hypertension in this age group.
Objectives
To quantify antihypertensive drug effect on overall mortality, cardiovascular mortality and morbidity and withdrawal due to adverse effects in people 60 years and older with mild to moderate systolic or diastolic hypertension.
Search methods
Updated search of electronic database of EMBASE, CENTRAL, MEDLINE until Dec 2008; previous search of two Japanese databases (1973‐1995) and WHO‐ISH Collaboration register (August 1997); references from reviews, trials and previously published meta‐analyses; and experts.
Selection criteria
Randomized controlled trials of at least one year duration in hypertensive elders (at least 60 years old) comparing antihypertensive drug therapy with placebo or no treatment and providing morbidity and mortality data.
Data collection and analysis
Outcomes assessed were total mortality (including cardiovascular, coronary heart disease and cerebrovascular mortality); total cardiovascular morbidity and mortality (representing combined coronary heart disease and cerebrovascular morbidity and mortality); and withdrawal due to adverse events.
Main results
Fifteen trials (24,055 subjects ≥ 60 years) with moderate to severe hypertension were identified. These trials mostly evaluated first‐line thiazide diuretic therapy for a mean duration of treatment of 4.5 years. Treatment reduced total mortality, RR 0.90 (0.84, 0.97); event rates per 1000 participants reduced from 116 to 104. Treatment also reduced total cardiovascular morbidity and mortality, RR 0.72 (0.68, 0.77); event rates per 1000 participants reduced from 149 to 106. In the three trials restricted to persons with isolated systolic hypertension the benefit was similar. In very elderly patients ≥ 80 years the reduction in total cardiovascular mortality and morbidity was similar RR 0.75 [0.65, 0.87] however, there was no reduction in total mortality, RR 1.01 [0.90, 1.13]. Withdrawals due to adverse effects were increased with treatment, RR 1.71 [1.45, 2.00].
Authors' conclusions
Treating healthy persons (60 years or older) with moderate to severe systolic and/or diastolic hypertension reduces all cause mortality and cardiovascular morbidity and mortality. The decrease in all cause mortality was limited to persons 60 to 80 years of age.
PICOs
Plain language summary
Blood pressure lowering drugs reduce stroke and heart attack in elderly people with hypertension
Hypertension (high blood pressure) is common among elderly people and increases the risk of heart attack and stroke. An assessment of all the trials of blood pressure lowering therapy in people with hypertension 60 years and over showed that treatment reduced death, strokes and heart attacks. The benefit was similar if both the upper and lower number was elevated or only the upper number. In people 80 and over treatment did not reduce death but did reduce stroke.
