BMJ  2008;336:1121-1123 (17 May), doi:10.1136/bmj.39548.738368.BE (published 14 May 2008)

Research

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

Blood Pressure Lowering Treatment Trialists’ Collaboration

Correspondence to: F Turnbull, Blood Pressure Lowering Treatment Trialists’ Collaboration, George Institute for International Health, University of Sydney, PO Box M201, Sydney, NSW 2050, Australia fturnbull{at}george.org.au

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.


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