Commentaries on "Embracing Complexity: A Consideration of Hypertension in the Very Old" and Author's Response: Commentary
Why the study?
Does antihypertensive drug therapy reduce cardiovascular events in very elderly patients (aged 80 years and older)?
Population
Very elderly patients (aged 80 years and older) with hypertension
Comparison
Antihypertensive drug therapy vs Placebo or no treatment
Design
Editorial
Authors
Discussion
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Member takes
Implication
Antihypertensive therapy in patients aged 80 years and older reduces the risk of stroke, heart failure, and major cardiovascular events, supporting the treatment of hypertension in the very elderly.
Key Points
- Evaluate cardiovascular risks associated with hypertension and assess the clinical benefits of antihypertensive drug therapy in individuals aged 80 years and older.
- Synthesized observational cohort data with 40- to 48-month follow-up evaluating new coronary events, atherothrombotic brain infarction, and congestive heart failure in older adults.
- Reviewed outcomes from the SHEP trial (N=650, aged ≥80 years) and an individual-patient meta-analysis of 7 randomized controlled trials (N=1670, mean age 83 years) comparing antihypertensive medication to placebo.
- Hypertension increased the relative risk of new coronary events (RR 2.0, 95% CI 1.5–2.5 in men; RR 1.6, 95% CI 1.5–2.5 in women), atherothrombotic brain infarction (RR 2.2, 95% CI 1.5–3.3 in men; RR 2.4, 95% CI 1.8–3.2 in women), and heart failure (risk ratio 2.5, 95% CI 2.1–2.9).
- A meta-analysis of 7 randomized trials demonstrated that antihypertensive drug therapy in individuals aged ≥80 years significantly decreased stroke by 34%, heart failure by 39%, and major cardiovascular events by 22%, with an insignificant 6% increase in all-cause mortality.
Structured PICO
Does antihypertensive drug therapy reduce cardiovascular events in very elderly patients (aged 80 years and older)?
P
Population
Very elderly patients (aged 80 years and older) with hypertension
I
Intervention
Antihypertensive drug therapy
C
Comparator
Placebo or no treatment
O
Outcome
Incidence of stroke, heart failure, coronary events, major cardiovascular events, and all-cause mortalityhard clinical
Antihypertensive therapy in patients aged 80 years and older reduces the risk of stroke, heart failure, and major cardiovascular events, supporting the treatment of hypertension in the very elderly.
Cite This Study
Wilbert S. Aronow (2003) studied this question.