BMJ, 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

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 P0.24). 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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drug choice and efficacy may depend on the aims of treatment

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bmj.com, 17 May 2008 [Full text]

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