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William J. Elliott, P-344: Treatment of hypertension in older persons: An updated meta-analysis, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 145A, https://doi.org/10.1016/S0895-7061(01)01940-9
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Abstract
People aged 60 years and older have been included in many clinical trials to assess the long-term benefits of treating hypertension. Two important meta-analyses on this topic were published in 1994, but several placebo-controlled trials have been reported since then. A thorough review of the world[scquote]s published literature, including all previously published meta-analyses, was therefore undertaken. A MEDLINE search and review of 264 publications (including 14 clinical studies) were primary source materials. Outcome events of interest included: All-cause mortality, cardiovascular (CV) mortality, cerebrovascular (CVA or stroke) mortality, coronary heart disease (CHD) deaths, strokes (fatal or non-fatal), myocardial infarctions (MIs), and all CV events. Numbers of events and participants were abstracted for both treatment and non-treatment groups, and organized in a computerized spreadsheet. Meta-analyses were performed using the Mantel-Haenzel and chi-square techniques. (See Table)
| Event . | Treated . | Placebo/No Rx . | Odds Ratio . | 95% CI . |
|---|---|---|---|---|
| Mortality | 1262 of 12262 | 1417 of 11734 | 0.85 | 0.79-0.92 |
| CV Deaths | 567 of 12179 | 758 of 11646 | 0.72 | 0.64-0.80 |
| CVA Deaths | 130 of 12179 | 208 of 11646 | 0.60 | 0.48-0.74 |
| CHD Deaths | 341 of 12179 | 443 of 11646 | 0.74 | 0.64-0.84 |
| Strokes | 445 of 11967 | 665 of 11484 | 0.64 | 0.57-0.72 |
| MIs | 554 of 11860 | 669 of 11385 | 0.79 | 0.71-0.89 |
| CV Events | 1352 of 11612 | 1763 of 10980 | 0.73 | 0.68-0.77 |
| Event . | Treated . | Placebo/No Rx . | Odds Ratio . | 95% CI . |
|---|---|---|---|---|
| Mortality | 1262 of 12262 | 1417 of 11734 | 0.85 | 0.79-0.92 |
| CV Deaths | 567 of 12179 | 758 of 11646 | 0.72 | 0.64-0.80 |
| CVA Deaths | 130 of 12179 | 208 of 11646 | 0.60 | 0.48-0.74 |
| CHD Deaths | 341 of 12179 | 443 of 11646 | 0.74 | 0.64-0.84 |
| Strokes | 445 of 11967 | 665 of 11484 | 0.64 | 0.57-0.72 |
| MIs | 554 of 11860 | 669 of 11385 | 0.79 | 0.71-0.89 |
| CV Events | 1352 of 11612 | 1763 of 10980 | 0.73 | 0.68-0.77 |
| Event . | Treated . | Placebo/No Rx . | Odds Ratio . | 95% CI . |
|---|---|---|---|---|
| Mortality | 1262 of 12262 | 1417 of 11734 | 0.85 | 0.79-0.92 |
| CV Deaths | 567 of 12179 | 758 of 11646 | 0.72 | 0.64-0.80 |
| CVA Deaths | 130 of 12179 | 208 of 11646 | 0.60 | 0.48-0.74 |
| CHD Deaths | 341 of 12179 | 443 of 11646 | 0.74 | 0.64-0.84 |
| Strokes | 445 of 11967 | 665 of 11484 | 0.64 | 0.57-0.72 |
| MIs | 554 of 11860 | 669 of 11385 | 0.79 | 0.71-0.89 |
| CV Events | 1352 of 11612 | 1763 of 10980 | 0.73 | 0.68-0.77 |
| Event . | Treated . | Placebo/No Rx . | Odds Ratio . | 95% CI . |
|---|---|---|---|---|
| Mortality | 1262 of 12262 | 1417 of 11734 | 0.85 | 0.79-0.92 |
| CV Deaths | 567 of 12179 | 758 of 11646 | 0.72 | 0.64-0.80 |
| CVA Deaths | 130 of 12179 | 208 of 11646 | 0.60 | 0.48-0.74 |
| CHD Deaths | 341 of 12179 | 443 of 11646 | 0.74 | 0.64-0.84 |
| Strokes | 445 of 11967 | 665 of 11484 | 0.64 | 0.57-0.72 |
| MIs | 554 of 11860 | 669 of 11385 | 0.79 | 0.71-0.89 |
| CV Events | 1352 of 11612 | 1763 of 10980 | 0.73 | 0.68-0.77 |
These data indicate that, across about 23,000 subjects in all trials, treatment of hypertension in older adults significantly reduces the risk of all types of major cardiovascular events, alone and in aggregate, including all-cause mortality. These data should reassure skeptics about the benefits of antihypertensive therapy for older people, who, by virtue of their age, are at high absolute cardiovascular risk. Grant/Research Support: Please see “RUSH University Standard Financial Disclosure Form”, enclosed. Major Stock Shareholder: None. I work at RUSH. Other Financial or Material Support: Please see “RUSH University Standard Financial Disclosure Form”, enclosed.
