Blood pressure lowering treatment in patients aged ≥75 years significantly reduced cardiovascular morbidity and mortality (p=0.0001) and heart failure (p=0.00001), but did not change total mortality.
Meta-Analysis (n=8,667)
Does blood pressure lowering treatment reduce cardio- and cerebrovascular endpoints in patients aged 75 years and older with moderate to severe hypertension?
Treating moderate to severe hypertension in patients aged 75 years and older significantly reduces non-fatal strokes, cardiovascular events, and heart failure, without affecting total mortality.
p-value: p=0.0001
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.
Schall et al. (Sun,) conducted a meta-analysis in Arterial hypertension (n=8,667). Blood pressure lowering treatment vs. Control / Placebo was evaluated on Cardiovascular morbidity and mortality (p=0.0001). Blood pressure lowering treatment in patients aged ≥75 years significantly reduced cardiovascular morbidity and mortality (p=0.0001) and heart failure (p=0.00001), but did not change total mortality.
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