Does antihypertensive treatment of the elderly prevent cardiovascular events or prolong life? A meta-analysis of hypertension treatment trials

Abstract

Objective: To estimate the short-term effects of drug treatment of hypertension in the elderly (> or = 60 years of age) on stroke, major coronary events, and mortality rates.

Design: Meta-analysis of all published randomized, controlled trials that addressed the impact of drug treatment of hypertension in the elderly on the above outcomes.

Setting and patients: All published clinical trials that met the above criteria involved men and women recruited from primary care practices or through community screenings, who were then treated according to protocol at either community or specialty clinics. Eight randomized, controlled trials that included 15,990 patients treated for an average of 4.6 years were included in this meta-analysis.

Interventions: Patients received either active antihypertensive treatment or placebo in seven of the studies and programmed stepped care vs referral back to the usual care source in one study.

Main outcome measures: Fatal or nonfatal myocardial infarction or sudden coronary death; fatal or nonfatal stroke; and all-cause mortality. Outcomes were analyzed on an intention-to-treat basis.

Results: Mean baseline blood pressure was 179/90 mm Hg, with a mean treatment effect of 15/6 mm Hg. Homogeneity tests indicated validity of the combined results. Pooled relative risks, calculated as treatment or control (with 95% confidence intervals) for the main end points, were as follows: fatal or nonfatal major coronary event, 0.82 (0.73 to 0.92); fatal or nonfatal stroke, 0.65 (0.57 to 0.75); and death from any cause, 0.85 (0.78 to 0.92) (P < .005 for each).

Conclusion: Antihypertensive treatment in the elderly prevents major coronary events and stroke and prolongs life, with significant treatment effects observed within only 5 years.