September 10, 2014
Older Adults Benefit From Antihypertensives, DespiteBarcelona, Spain—Despite concerns about side effects, antihypertensives should continue to be prescribed for older adults because the drugs significantly reduce the risk of cardiovascular (CV) events, strokes, and mortality, according to a new international study.
The retrospective review, presented recently at the European Society of Cardiology (ESC) conference in Barcelona as abstract 6588, found few risks associated with the treatment other than an increased incidence of falling.
“Antihypertensive therapy in older adults is very effective and should be considered in all patients over 65 years of age with hypertension, as it significantly reduces the risk of CV events, strokes, and mortality,” said lead researcher Dr. Maciej Ostrowski of the Medical University of Lodz in Poland. “All patients should be made aware of the large benefits of this therapy.”
The study, conducted through the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, sought to investigate the effect of hypertension therapy on blood pressure (BP), CV, and mortality outcomes in patients over the age of 65 years, while also analyzing the safety of BP lowering in older adults.
For the meta-analysis, researchers looked at data published from 1966 to 2013 on Scopus, PubMed, Web of Science, and the Cochrane Central Register of randomized controlled trials (RCTs) for appropriate studies. Included were 11 RCTs with 40,325 hypertensive older patients randomized to receive either antihypertensive drugs or placebo.
Results indicate that BP-lowering therapy was associated with a significant reduction in systolic BP of 12.43 mmHg and diastolic BP of 5.06 mmHg. The therapy also reduced the all-cause mortality rate by 13%, the risk of death from all-cardiac causes by 18%, CV events by 21% and stroke by 30%, including fatal stroke by 39%.
The risk of hospitalization for angina pectoris or heart failure did not rise with antihypertensive medication prescriptions, but an association between BP lowering and the risk of falls was observed (1.21, 95% CI: 1.05-1.44; P < 0.05).
“There are still very limited data on possible complications associated with BP lowering in this group of patients, especially the risk of falls which needs to be investigated further,” Ostrowski noted. “Therefore physicians must remember that in older patients BP therapy should be individualized, with BP goals adapted to individual tolerability.”
He also pointed out that the LBPMC Group now is conducting a second meta-analysis to answer the question of optimal BP goals in older adults.
“Over the past few decades, a number of randomized trials and meta‑analyses have supported the benefits of antihypertensive medication in reducing the incidence of cardiovascular disease among hypertensive patients over the age of 65 years. However, these studies were not designed to identify the appropriate target blood pressure in this population,” he explained.
“There is also still a large debate on the optimal target BP level for older adults with hypertension, especially concerning whether systolic BP reduction below 140 mmHg is beneficial and safe. Experts have emphasized that very limited data exist to make definitive recommendations on how low we should reduce BP in older patients, and that data are lacking on the effects of hypertensive therapy in this group of patients,” Ostrowski added.
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