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1 September 1994 | Volume 121 Issue 5 | Pages 355-362
Purpose: A meta-analysis of the effect of antihypertensive drug treatment on mortality and morbidity in elderly patients.
Data sources: A literature search of published articles from January 1980 to February 1992.
Study selection: Randomized controlled trials of drug treatment of hypertension with end points for elderly patients reported separately.
Data extraction: Mortality or morbidity end points or both in patients older than 59 years were pooled by determination of typical odds ratio. A meta-regression was used to study heterogeneity.
Results: Nine major trials with 15 559 patients older than 59 years were identified. Death rates in the control group varied between 2.7% and 77.2%; stroke and coronary mortality increased with the severity-of-illness rank (P < 0.001). Overall, treated patients had an approximately 12% reduction in all-cause mortality (odds ratio, 0.88; 95% CI, 0.80 to 0.97; 953 events compared with 1069 events, P = 0.009). There was a 36% reduction in stroke mortality (odds ratio, 0.64; CI, 0.49 to 0.82; 94 events compared with 149 events, P < 0.001) and a 25% reduction in coronary heart disease mortality (odds ratio, 0.75; CI, 0.64 to 0.88; 263 events compared with 350 events, P < 0.001). Coronary morbidity was reduced 15% (odds ratio, 0.85; CI, 0.73 to 0.99; 325 events compared with 379 events, P = 0.036), and stroke morbidity was reduced 35% (odds ratio, 0.65; CI, 0.55 to 0.76; 247 events compared with 382 events, P < 0.001).
Conclusion: Overall, treatment of hypertension in elderly patients produces a significant benefit in total mortality and cardiovascular morbidity and mortality. However, this benefit may be reduced in the oldest age groups.
Author and Article Information
From the Mount Sinai School of Medicine, New York, New York and Harvard University School of Public Health and the New England Medical Center, Boston, Massachusetts.
REVIEW
Drug Treatment of Hypertension in the Elderly
A Meta-Analysis
Requests for Reprints: Henry S. Sacks, MD, Clinical Trials Unit, Mount Sinai School of Medicine, Box 1042, New York, NY, 10029.
Grant Support: In part by the Robert Wood Johnson, Jr. Charitable Trust and by grants HS 05936 and HS 077A2-01 from the Agency for Health Care Policy and Research of the United States Public Health Service.
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