Antihypertensive Tx Benefits, Harms Evaluated in Older Patients With Mild to Moderate Hypertension

Antihypertensive therapy reduces all-cause mortality as well as cardiovascular, cerebrovascular, and coronary heart disease (CHD) morbidity and mortality in patients ≥60 years old with moderate to severe systolic and/or diastolic hypertension, according to findings from an updated review on pharmacotherapy for hypertension in older adults.

To better understand the effect of antihypertensive pharmacotherapy in older patients with hypertension, the study authors searched multiple databases for randomized controlled trials (at least 1 year’s duration) where antihypertensive drug therapy was compared with placebo or no treatment and data on morbidity/mortality outcomes in patients ≥60 years old with blood pressure >140/90 mmHg was available.

Sixteen trials (n=26,795 patients; mean age: 73.4 years; average blood pressure: 182/95 mmHg) met the study author’s inclusion criteria. It was noted that the majority of these trials assessed first-line thiazide diuretic therapy over an average duration of 3.8 years.

Review of moderate- to high-certainty evidence revealed that, compared with control, antihypertensive pharmacotherapy reduced all-cause mortality (risk ratio [RR]: 0.91; 95% CI: 0.85, 0.97), cardiovascular morbidity and mortality (RR: 0.72; 95% CI: 0.68, 0.77), cerebrovascular morbidity and mortality (RR: 0.66; 95% CI: 0.59, 0.74), as well as CHD morbidity and mortality (RR: 0.78; 95% CI: 0.69, 0.88).

Study findings also revealed a higher withdrawal rate due to adverse events in patients who received antihypertensive therapy (15.7%) compared with those in the control group (5.4%) (RR: 2.91; 95% CI: 2.56, 3.30; low-certainty evidence). The authors noted that benefits appeared to be similar in the 3 studies that were restricted to patients with isolated systolic hypertension.

“This comprehensive systematic review provides additional evidence that the reduction in mortality observed was due mostly to reduction in the 60- to 79-year-old patient subgroup (high-certainty evidence; RR 0.86, 95%CI 0.79 to 0.95),” the study authors stated. They added, “Although cardiovascular mortality and morbidity were significantly reduced in both subgroups 60 to 79 years old (moderate-certainty evidence; RR 0.71, 95% CI 0.65 to 0.77) and 80 years or older (moderate-certainty evidence; RR 0.75, 95% CI 0.65 to 0.87), the magnitude of absolute risk reduction was probably higher among 60- to 79-year-old patients (3.8% vs 2.9%).”

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