Treatment of hypertension is recommended for reducing mortality and cardiovascular and cerebrovascular morbidity in the elderly.
The recommendation is strong because of positive effect on patient important outcomes, and the cost of blood pressure medication is low.
A Cochrane review[Abstract] 1 included 16 studies with a total of 26 795 subjects 60 years or older (mean age 73.4 years) with moderate to severe systolic and/or diastolic hypertension (average 182/95 mmHg). A stepped care approach to hypertension treatment was applied in 13 studies. In over 70% of trials a thiazide diuretic was the first line drug; also beta blockers, calcium blockers, and ACE inhibitors were used. Second- and third-line drugs included diuretics, beta blockers, centrally acting antiadrenergic agents, peripherally acting antiadrenergic agents, vasodilators, converting-enzyme inhibitors, and calcium channel blockers. Length of study follow-up ranged from 1 to 6 years, a mean duration of treatment was 3.8 years.
Antihypertensive drug treatment reduced all-cause mortality, cardiovascular mortality and morbidity, cerebrovascular mortality and morbidity, and coronary heart disease mortality and morbidity (table T1). Withdrawals due to adverse effects were increased with treatment. Three studies were restricted to subjects with isolated systolic hypertension, and they reported similar benefits.
The reduction in mortality observed was due mostly to reduction in the 60-79-year-old patient subgroup. Although cardiovascular mortality and morbidity was significantly reduced in both subgroups 60-79 years old (RR 0.71, 95% CI 0.65 to 0.77) and 80 years or older (RR 0.75, 95% CI 0.65 to 0.87), the magnitude of absolute risk reduction was probably higher among 60-79-year-old patients (3.8% vs 2.9%). The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity.
| Outcome | Relative effect(95% CI) | Risk with control | Risk with antihypertensive drug therapy (95% CI) | NNTB/NNTH | Participants (studies) |
|---|---|---|---|---|---|
| CV = cardiovascular; CHD = coronary heart disease | |||||
| Total mortality | RR 0.91 (0.85 to 0.97) | 110 per 1000 | 100 per 1000(93 to 106) | NNTB 100 | 25 932(13) |
| CV mortality and morbidity | RR 0.72 (0.68 to 0.77) | 136 per 1000 | 98 per 1000(92 to 104) | NNTB 27 | 26 747(15) |
| Cerebrovascular mortality and morbidity | RR 0.66 (0.59 to 0.74) | 52 per 1000 | 34 per 1000(31 to 39) | NNTB 56 | 26 042(13) |
| CHD mortality and morbidity | RR 0.78 (0.69 to 0.88) | 48 per 1000 | 37 per 1000(33 to 42) | NNTB 91 | 24 559(11) |
| Withdrawals due to adverse effects | RR 2.91 (2.56 to 3.30) | 54 per 1000 | 157 per 1000(138 to 178) | NNTH 10 | 11 310(4) |
Primary/Secondary Keywords