Should the elderly hypertensive be treated? Evidence from clinical trials

Clinical trials for over 15 years have addressed the therapeutic utility of treating elderly hypertensives. Many early trials showed no treatment effects. Because of the recent publication of new information, a review of available evidence concerning this issue was undertaken. Eight randomized clinical trials were assessed regarding trial design. The studies varied according to generalizability, diagnostic criteria, choice of therapy, outcome measures assessed, evaluation of compliance, methods of analysis, duration of follow-up, determination of side effects, and ability to exclude a type 2 error. While many of the earlier studies found no treatment effects, they lacked methodologic rigor; more recent studies demonstrated positive treatment effects. Pooling of results from similar trials supports a notable treatment effect in the prevention of stroke. There is also evidence that the elderly are not more susceptible to side effects of antihypertensive drugs, as is generally believed. The best evidence suggests the hypertensive elderly should be treated.