Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials

Abstract

Objective To quantify the relative risk reductions achieved with different regimens to lower blood pressure in younger and older adults. Design Meta-analyses and meta-regression analyses used to compare the effects on the primary outcome between two age groups (<65 v ≥65 years). Evidence for an interaction between age and the effects of treatment sought by fitting age as a continuous variable and estimating overall effects across trials. Main outcome measures Primary outcome: total major cardiovascular events. Results 31 trials, with 190 606 participants, were included. The meta-analyses showed no clear difference between age groups in the effects of lowering blood pressure or any difference between the effects of the drug classes on major cardiovascular events (all P≥0.24). Neither was there any significant interaction between age and treatment when age was fitted as a continuous variable (all P>0.09). The meta-regressions also showed no difference in effects between the two age groups for the outcome of major cardiovascular events (<65 v ≥65; P=0.38). Conclusions Reduction of blood pressure produces benefits in younger (<65 years) and older (≥65 years) adults, with no strong evidence that protection against major vascular events afforded by different drug classes varies substantially with age.

Blood pressure guidelines – where are we now?

“…In that study, stroke (a secondary outcome) was less likely in patients treated with the amlodipine-based regimen than with the atenolol-based regimen (hazard ratio [HR] 0.77, 95% CI 0.66 to 0.89). However, subsequent analysis suggests that such a difference reflected the consistently lower blood pressure achieved in the amlodipine group11 and supports the view that the major effect on cardiovascular outcomes is achieved by blood pressure lowering rather than being dependent on the type of drug used 12 , 13…”

“…Of note, a recently published meta-analysis of 31 randomised controlled trials (involving a total of 190,606 patients) shows no difference between age groups (i.e. less than 65 years or over 65 years) in the effects of blood-pressure lowering therapies 12. It might be argued that these age limits differ from those used in the NICE guideline and the difference in mean age between the older and younger patients included in the analysis was not large (around 15 years) 12.…”

Kidney Disease in Obesity and Metabolic Syndrome

“…A meta-analysis of randomized Metabolic Syndrome DOI 10.1007/978-3-319-12125-3_49-1 # Springer International Publishing Switzerland 2015 trials comparing the effectiveness of different anti-hypertensive therapies ultimately did not indicate a preferred medication (Turnbull et al 2008), but an angiotensin-converting enzyme inhibitor (ACE-i) or angiotensin receptor blocker (ARB) is the consensus recommendation for those with MetS (Bestermann et al 2005). Given the increased risk for insulin resistance in this patient population, ACE-i or ARB initiation seems to have a protective benefit against the development of diabetes, with a reduction in the incidence of diabetes of 25-27 % (Abuissa et al 2005).…”

China Stroke Primary Prevention Trial: Visit‐to‐Visit Systolic Blood Pressure Variability Is an Independent Predictor of Primary Stroke in Hypertensive Patients

“…In China, ≈200 million people suffer from hypertension 6. The diagnosis and treatment of hypertension focus on comparisons to the normal blood pressure (BP) range,7, 8, 9 which is calculated by the average BP during a defined period, according to all major clinical guidelines 10, 11, 12. Recently, debate has ensued regarding the optimal BP level.…”