Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials

Autor:	François Gueyffier, Jean-Pierre Boissel, Edoardo Casiglia, Christopher J. Bulpitt, Eleanor Schron, Karla Kerlikowske, Robert Fagard, Tord Ekbom, John Coope
Rok vydání:	1999
Předmět:	medicine.medical_specialty Chemotherapy Heart disease Vascular disease business.industry medicine.medical_treatment General Medicine medicine.disease Surgery Central nervous system disease Internal medicine Heart failure Meta-analysis medicine In patient business Stroke
Zdroj:	The Lancet. 353:793-796
ISSN:	0140-6736
DOI:	10.1016/s0140-6736(98)08127-6
Popis:	Summary Background Beneficial clinical effects of treatment with antihypertensive drugs have been shown in middle-aged patients and in those hypertensive patients over 60 years old, but whether treatment is beneficial in patients over 80 years old is not known. Methods We collected data from all participants aged 80 years and over in randomised controlled trials of antihypertensive drugs through direct contact with study investigators. Our primary outcome was fatal and non-fatal stroke. Secondary outcomes were death from all causes, cardiovascular death, fatal and non-fatal major coronary and cardiovascular events, and heart failure. Findings There were 57 strokes and 34 deaths among 874 actively treated patients, compared with 77 strokes and 28 stroke deaths among 796 controls, representing 1 non-fatal stroke prevented for about 100 patients treated each year. The meta-analysis of data from 1670 participants aged 80 years or older suggested that treatment prevented 34% (95% CI 8–52) of strokes. Rates of major cardiovascular events and heart failure were significantly decreased, by 22% and 39%, respectively. However, there was no treatment benefit for cardiovascular death, and a non-significant 6% (-5 to 18) relative excess of death from all causes. Interpretations The inconclusive findings for mortality contrast with the benefit of treatment for non-fatal events. Results of a large-scale specific trial are needed for definite conclusion that antihypertensive treatment is beneficial in very elderly hypertensive patients. Meanwhile, an age threshold beyond which hypertension should not be treated cannot be justified.
Databáze:	OpenAIRE
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