Reducing blood pressure in people of different ages

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39560.541725.80 (Published 15 May 2008) Cite this as: BMJ 2008;336:1080
  1. Jan A Staessen, academic consultant1,
  2. Tom Richart, research fellow2,
  3. Paolo Verdecchia, hospital based cardiologist 3
  1. 1Studies Coordinating Centre, Laboratory of Hypertension, Campus Gasthuisberg, B-3000 Leuven, Belgium
  2. 2Department of Epidemiology, Maastricht University, Maastricht, Netherlands
  3. 3Dipartimento Malattie Cardiovascolari, Hospital Santa Maria della Misericordia, University of Perugia, Perugia, Italy
  1. jan.staessen{at}med.kuleuven.be

Absolute benefit increases with age and management of overall cardiovascular risk

In the accompanying paper, the Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC) compares the effects of different regimens for reducing blood pressure in different age groups.1 The meta-analysis found that across 31 trials of more than 190 000 randomised patients, the reduction in blood pressure with various antihypertensive drugs was independent of the patients’ ages.

Previous large scale prospective observational studies and meta-regression analyses have highlighted the role of reducing blood pressure for preventing cardiovascular complications in patients with hypertension.2 3 4 5 The new BPLTTC analysis shows that the relative risk reduction of a cardiovascular event with tighter blood pressure control occurs irrespective of the patient’s age.1

One potential limitation of the BPLTTC analysis is that the age difference between younger and older patients was only about 15 years, and that 65 years was the arbitrary cut off between younger and older patients. However, subsidiary analyses with age fitted as a continuous variable provided better statistical power and reassurance that moderate or large age related effects had not been missed.1


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