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Medicamentos antihipertensivos en personas muy viejas: un subgrupo metaanálisis de ensayos controlados aleatorios. El
F Gueyffier1, C Bulpitt, J P Boissel
1Clinical Pharmacology Department, Claude Bernard University, Lyon Hospitals, France. fg@upcl.univ.lyon1.fr
Lancet (London, England)
|August 25, 1999
Resumen
El tratamiento con fármacos antihipertensivos en pacientes mayores de 80 años redujo significativamente los accidentes cerebrovasculares y la insuficiencia cardíaca, pero no mostró ningún beneficio para la muerte cardiovascular. Se necesita más investigación para obtener conclusiones definitivas sobre los beneficios de la mortalidad en este grupo de edad.
Área de la Ciencia:
- Gerontología Gerontología.
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Farmacología clínica Farmacología clínica.
Sus antecedentes:
- Los beneficios de los fármacos antihipertensivos se han establecido en adultos jóvenes y mayores.
- La eficacia del tratamiento de la hipertensión en personas mayores de 80 años sigue siendo incierta.
Objetivo del estudio:
- Evaluar la eficacia clínica del tratamiento con fármacos antihipertensivos en pacientes de 80 años o más.
- Para determinar el impacto en el accidente cerebrovascular, la mortalidad, los eventos cardiovasculares y la insuficiencia cardíaca en esta población.
Principales métodos:
- Un metanálisis de los datos de ensayos controlados aleatorios en los que participaron participantes de 80 años o más.
- El resultado primario: accidente cerebrovascular fatal y no fatal.
- Resultados secundarios: mortalidad por todas las causas, muerte cardiovascular, eventos cardiovasculares importantes y insuficiencia cardíaca.
Principales resultados:
- El tratamiento de 1670 participantes mayores de 80 años evitó el 34% de los accidentes cerebrovasculares.
- Se observaron reducciones significativas en los principales eventos cardiovasculares (22%) y en la insuficiencia cardíaca (39%).
- No hay beneficio significativo para la muerte cardiovascular; se observó un exceso no significativo del 6% en la mortalidad por todas las causas.
Conclusiones:
- El tratamiento antihipertensivo ofrece beneficios para los eventos cardiovasculares no fatales en pacientes muy ancianos.
- Los hallazgos no concluyentes con respecto a la mortalidad requieren ensayos a gran escala para conclusiones definitivas.
- La evidencia actual no justifica un umbral de edad para interrumpir el tratamiento de la hipertensión.
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