Related Experiment Videos
Review of the major hypertension trials in the elderly
J Staessen1, R Fagard, P Lijnen
1Department of Pathophysiology, University of Leuven, Belgium.
Insights
Hypotensive drug treatment in elderly hypertensives may reduce cardiovascular deaths, primarily by lowering cerebrovascular mortality. However, its benefit in specific patient groups and optimal blood pressure targets require further investigation.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Elderly hypertensives represent a significant population for cardiovascular risk management.
- Existing intervention trials provide insights into the effects of hypotensive drug treatment.
Purpose of the Study:
- To evaluate the impact of hypotensive drug treatment on cardiovascular and cerebrovascular mortality in elderly hypertensive patients.
- To determine the established benefits and uncertainties of blood pressure management in specific elderly subgroups.
Main Methods:
- Analysis of data from various intervention trials in elderly hypertensive populations.
- Assessment of cardiovascular and cerebrovascular event rates in treated versus untreated or placebo groups.
Main Results:
- Intervention trials support the hypothesis that hypotensive drug treatment reduces cardiovascular mortality, largely driven by decreased cerebrovascular mortality.
- A significant reduction in both fatal and nonfatal cardiovascular events was observed, primarily due to fewer cerebrovascular events.
Conclusions:
- Hypotensive drug treatment appears beneficial for reducing cardiovascular and cerebrovascular mortality in elderly hypertensives.
- Further research is needed to establish the efficacy and safety of hypotensive drug treatment in asymptomatic patients with isolated systolic hypertension and in very elderly patients (above 80) with uncomplicated hypertension.
- The optimal blood pressure targets and the safety of aggressive blood pressure reduction require additional investigation.
Abstract:
The different intervention trials in elderly hypertensives are compatible with the hypothesis that hypotensive drug treatment can decrease cardiovascular mortality mainly by decreasing cerebrovascular mortality. A decrease in the fatal and nonfatal cardiovascular event rate is mainly due to a decrease in cerebrovascular events. It is not established whether hypotensive drug treatment is advisable in symptomless patients with isolated systolic hypertension and in patients with uncomplicated hypertension above age 80. A sudden reduction in blood pressure should be avoided, but whether a progressive reduction of systolic blood pressure below 140 mmHg and of diastolic blood pressure below 85 mmHg is dangerous or advantageous remains to be established.