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The older hypertensive. Assessment and treatment
H Celis1, R Fagard, J Staessen
1Department of Pathophysiology, Katholieke Universiteit, Leuven, Belgium.
Insights
This meta-analysis shows that treating elderly hypertensive patients reduces cardiovascular mortality by 22%. However, treatment effectiveness is uncertain for those with lower diastolic blood pressure or over 75 years old.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Hypertension is a significant risk factor for cardiovascular events in the elderly.
- Therapeutic interventions aim to reduce mortality and morbidity associated with high blood pressure.
Purpose of the Study:
- To evaluate the efficacy of antihypertensive therapy in elderly patients through a meta-analysis of randomized controlled trials.
- To identify specific patient subgroups and blood pressure targets for effective treatment.
Main Methods:
- Meta-analysis of 8 therapeutic trials involving elderly hypertensive patients.
- Intention-to-treat analysis was employed to assess cardiovascular mortality outcomes.
Main Results:
- Antihypertensive therapy resulted in a 22% average reduction in cardiovascular mortality.
- Significant reductions were observed in coronary mortality (26%) and cerebrovascular mortality (33%).
- Treatment efficacy was less certain in patients with diastolic blood pressure <95 mmHg or age >75 years.
Conclusions:
- Therapeutic intervention for hypertension in the elderly significantly reduces cardiovascular mortality.
- A systolic blood pressure target of approximately 150 mmHg may be optimal.
- Diuretics and beta-blockers are recommended as first-line agents for uncomplicated hypertension in the elderly.
Abstract:
A meta-analysis is presented of 8 therapeutic trials in elderly hypertensive patients. In an intention-to-treat analysis, cardiovascular mortality was decreased on average by 22% (95% confidence interval ranging from -32% to -10%). This decrease was explained by both a reduction in coronary mortality by 26% (-40% to -9%) and in cerebrovascular mortality by 33% (-50% to -9%). The effectiveness of therapy in terms of reducing cardiovascular mortality is not established with confidence in those trials where the diastolic blood pressure at randomization is below 95 mmHg or in the patients above 75 years of age. A goal blood pressure is not definitively established, but a reduction of the systolic blood pressure to about 150 mmHg may be optimal. Extrapolation of the trial results to the elderly population with systolo-diastolic hypertension at large seems acceptable for the western population, but may be premature for the Asian and African elderly. Beta-blockers and especially diuretics are recommended as first-line drugs in elderly patients with symptomless, uncomplicated hypertension, since the effectiveness of other drugs in reducing morbidity and mortality is not yet established. Recommendation for treatment of symptomless patients with isolated systolic hypertension may be premature. The ongoing Syst-Eur and Syst-Chin trials may provide further information.