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Drug Treatment of Hypertension in the Elderly: A Meta-Analysis

Jorge T. Insua; Henry S. Sacks; Tai-Shing Lau; Joseph Lau; Dinah Reitman; Daniel Pagano; and Thomas C. Chalmers
[+] Article and Author Information

From the Mount Sinai School of Medicine, New York, New York and Harvard University School of Public Health and the New England Medical Center, Boston, Massachusetts. Requests for Reprints: Henry S. Sacks, MD, Clinical Trials Unit, Mount Sinai School of Medicine, Box 1042, New York, NY, 10029. Grant Support: In part by the Robert Wood Johnson, Jr. Charitable Trust and by grants HS 05936 and HS 077A2-01 from the Agency for Health Care Policy and Research of the United States Public Health Service.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;121(5):355-362. doi:10.7326/0003-4819-121-5-199409010-00008
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Purpose: A meta-analysis of the effect of antihypertensive drug treatment on mortality and morbidity in elderly patients.

Data sources: A literature search of published articles from January 1980 to February 1992.

Study selection: Randomized controlled trials of drug treatment of hypertension with end points for elderly patients reported separately.

Data extraction: Mortality or morbidity end points or both in patients older than 59 years were pooled by determination of typical odds ratio. A meta-regression was used to study heterogeneity.

Results: Nine major trials with 15 559 patients older than 59 years were identified. Death rates in the control group varied between 2.7% and 77.2%; stroke and coronary mortality increased with the severity-of-illness rank (P < 0.001). Overall, treated patients had an approximately 12% reduction in all-cause mortality (odds ratio, 0.88; 95% CI, 0.80 to 0.97; 953 events compared with 1069 events, P = 0.009). There was a 36% reduction in stroke mortality (odds ratio, 0.64; CI, 0.49 to 0.82; 94 events compared with 149 events, P < 0.001) and a 25% reduction in coronary heart disease mortality (odds ratio, 0.75; CI, 0.64 to 0.88; 263 events compared with 350 events, P < 0.001). Coronary morbidity was reduced 15% (odds ratio, 0.85; CI, 0.73 to 0.99; 325 events compared with 379 events, P = 0.036), and stroke morbidity was reduced 35% (odds ratio, 0.65; CI, 0.55 to 0.76; 247 events compared with 382 events, P < 0.001).

Conclusion: Overall, treatment of hypertension in elderly patients produces a significant benefit in total mortality and cardiovascular morbidity and mortality. However, this benefit may be reduced in the oldest age groups.

Figures

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Figure 1.
Results of meta-analysis of mortality end points.Left.Right.

Absolute numbers. Odds ratios and 95% confidence intervals. ANBP = Australian National Blood Pressure Study; EWPHE = European Working Party on High Blood Pressure in the Elderly; HDFP = Hypertension Detection and Follow-up Program; MRC = Medical Research Council; PPC = Practice in Primary Care; SHEP = Systolic Hypertension in the Elderly; STOP = Swedish Trial in Old Patients with Hypertension; VA = Veterans Administration Cooperative Study on Antihypertensive Agents.

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Figure 2.
Results of meta-analysis of morbidity end points.Left.Right.

Absolute numbers. Odds ratios and 95% confidence intervals. ANBP = Australian National Blood Pressure Study; EWPHE = European Working Party on High Blood Pressure in the Elderly; HDFP = Hypertension Detection and Follow-up Program; MRC = Medical Research Council; PPC = Practice in Primary Care; SHEP = Systolic Hypertension in the Elderly; STOP = Swedish Trial in Old Patients with Hypertension.

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Figure 3.
Mortality in control patients according to the severity-of-illness rank of the seven trials that could be ranked.[13]

* = Overall mortality rate given because individual rates were unavailable. ANBP = Australian National Blood Pressure Study; CHD = coronary heart disease; EWPHE = European Working Party on High Blood Pressure in the Elderly; HDFP = Hypertension Detection and Follow-up Program; MRC = Medical Research Council; PPC = Practice in Primary Care; SHEP = Systolic Hypertension in the Elderly; SPRACK = Sprackling and colleagues .

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