title: Treatment of arterial hypertension in the very elderly: a meta-analysis of clinical trials.
abstract: The benefits of lowering blood pressure are obvious for the population up to the age of 65 years, but whether and, if so, which treatment is beneficial in the very elderly population remains still a matter of debate. We conducted a meta-analysis of randomised controlled clinical trials with duration of at least 12 months and the analysis of cardio- and cerebrovascular endpoints in participants aged 75 years and over. MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials) and the WHO-ISH Collaboration register were searched until October 20, 2009. Further, references from reviews, trials and previously published meta-analyses were analysed. A total of 10 studies were included providing morbidity and mortality data with a total of 8667 participants in the meta-analysis, with separate analyses for studies on isolated systolic hypertension. There were 148 non-fatal strokes and 287 cardiovascular morbidity and mortality events among treated patients, compared with 176 non-fatal strokes (p = 0.02) and 366 cardiovascular morbidity and mortality events (p = 0.0001) among control patients. Rates of heart failure were significantly reduced (64 vs. 121 events; p = 0.00001), total mortality remained unchanged (odds ratio 0.97). Further, 9 studies with 6933 participants were included in the systematic review of blood pressure reduction trials. The average blood pressure achieved at the end of the studies was 164/83 mmHg in the placebo group and 150/83 mmHg in the treatment group. At the beginning of the study blood pressure was 170.6/ 88.6 mmHg in the placebo group and 175.4/94.6 mmHg in the treatment group. Changes were only significant for systolic blood pressure in the treatment group (p = 0.0008). Treating healthy subjects aged 75 years and older with moderate to severe hypertension reduces non-fatal strokes, cardiovascular morbidity and mortality and the incidence of heart failure but does not change total mortality.
authors.affiliation: Medical Clinic IV (Geriatrics), Faculty of Medicine Mannheim, University of Heidelberg, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Schall
authors.forename: Martin
authors.initials: M
authors.lastname: Wehling
mesh_terms: D000368:Aged / Q000502:physiology*; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002986:Clinical Trials as Topic; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D020521:Stroke / Q000453:epidemiology / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents