Michael W. Rich, MD
Are different classes of drugs to lower blood pressure (BP) similarly effective for preventing major cardiovascular events in younger (< 65 y) and older (≥ 65 y) patients?
Studies selected compared drugs that lower BP with placebo, a less-intensive BP-lowering regimen, or a different class of BP-lowering drug. Primary outcome was major cardiovascular event (fatal or nonfatal stroke, myocardial infarction, or heart failure).
In a prespecifed protocol, the review was to include ongoing or planned randomized controlled trials (RCTs) that had ≥ 1000 patient-years of planned follow-up per group and no results presented before July 1995 (date of protocol finalization). Of 37 eligible trials, individual patient data were provided for 25 RCTs and categorized data for 6 RCTs, including 96 466 patients < 65 years of age (mean age 57 y, 58% men) and 94 140 patients ≥ 65 years of age (mean age 72, 51% men).
Using 3 different methods of analysis (meta-analysis by trial subgrouped by age < 65 or ≥ 65 y [Table], meta-analysis by patient using continuous age, and meta-regression assessing risk reduction per unit reduction in BP by age group), the review found no difference in reduction in cardiovascular events by age for any treatment comparison.
Drugs to lower blood pressure are similarly effective for preventing major cardiovascular events in younger and older patients. No evidence was found for selective use of a specific drug class based on age.
Blood pressure–lowering drugs for preventing major cardiovascular events in younger and older patients*
*ACE = angiotensin-converting enzyme; ARB = angiotensin-receptor blocker; CA = calcium antagonist; CI defined in Glossary.
†For homogeneity of treatment effect; P values > 0.05 suggest the treatment effect is similar between age groups.
Rich MW. Review: Blood pressure–lowering drugs prevent cardiovascular events equally well in younger and older patients. Ann Intern Med. ;149:JC3–10. doi: 10.7326/0003-4819-149-6-200809160-02010
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Published: Ann Intern Med. 2008;149(6):JC3-10.
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