Should we prefer different drugs to treat hypertension in older and younger adults? Practical implications of clinical trials: American perspective.
Whether older and younger persons derive similar benefit from antihypertensive treatment and whether treatment choices should be tailored to the age of the patient are unresolved issues about which there is a paucity of evidence. The Blood Pressure Lowering Treatment Trialists' Collaboration has attempted to address this deficiency in a meta-analysis that included 31 trials with 190,606 participants. They compared the proportionate risk reductions achieved with different classes of antihypertensive drugs in younger (< 65 years) and older (> 65 years) adults. They reported that there was no clear evidence to support recommendations for particular antihypertensive drug classes in older or younger adults. In this paper we discussed the Trialists' paper and its limitations and strenghts, current guidelines recommendations, and the major conclusions that are important for clinicians.
Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, Sao Paulo, SP, Brazil. espimenta@hotmail.com
Eduardo
E
Pimenta
Suzanne
S
Oparil
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D040261:Harm Reduction; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D015201:Meta-Analysis as Topic; D009656:North America; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers