Journal article Open Access

Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials

Gueyffier, François; Bulpitt, Christopher; Boissel, Jean-Pierre; Schron, Eleanor; Ekbom, Tord; Fagard, Robert; Casiglia, Edoardo; Kerlikowske, Karla; Coope, John

Background : A beneficial clinical effect of antihypertensive drug treatment has been observed in middle age and in those hypertensive patients over 60 years old, but uncertainty remains on its benefit after 80 years of age. The ageing of the general population, and the increasing prevalence of hypertension with age, make this an important public health question. Methods : We collected data from all participants aged 80 years and over in randomised controlled trials of antihypertensive drug treatment, through direct contacts of study investigators. Our primary outcome was fatal and non-fatal stroke. Secondary outcomes were death from all causes, cardiovascular death, fatal and non-fatal major coronary and cardiovascular events, and heart failure. Findings : The meta-analysis of data from 1670 participants aged 80 years or more suggested that treatment prevented 34% (95% CI : 8 to 52%) of strokes. Also, major cardiovascular events and heart failure were significantly reduced by 22% and 39%, respectively. However, there was no benefit for cardiovascular death, and a non-significant 6% relative excess of death from all causes (95% CI : -5% to 18%). Interpretation : The inconclusive findings for mortality contrast with the benefit observed on non-fatal events, and illustrate the need to have the results of a large scale specific trial, before definitely concluding that antihypertensive treatment is beneficial in very elderly hypertensives. Meanwhile, there is no solid argument to fix a threshold of age above which hypertension should not be treated.
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