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Weiss J, Kerfoot A, Freeman M, et al. Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis [Internet]. Washington (DC): Department of Veterans Affairs (US); 2016 Apr.
Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis [Internet].
Show detailsTable 12Detailed Results of Trials that Conducted Age-stratified Analyses
| Study Comparison, T vs C | Age groups (N patients) | Results comparing T vs C, by outcome and age group |
|---|---|---|
| Studies that compared BP targets (mm Hg) | ||
| ACCORD37 SBP < 120 vs < 140 | < 65 ≥ 65 (Total N = 4733; n per age group not reported) | Unadjusted HR for combined nonfatal MI, nonfatal stroke, and cardiovascular death (95% CIs not reported, but were not statistically significant, interpreted from graph): < 65: 0.90 ≥ 65: 0.91 Age interaction P-value = .98 |
| HOT38 DBP ≤ 80 vs ≤ 85 vs ≤ 90 | < 65 (n = 12803) ≥ 65 (n = 5987) | Events/1000 patient-years by DBP group ≤ 80 vs ≤ 85 vs ≤ 90 mm Hg (P-value for trend; HR calculated from event rates, 95% CI not reported): Total mortality: < 65: 5.7 vs 5.5 vs 4.5 (P = .13) HR ≤ 80 vs ≤ 85: 1.04 HR ≤ 80 vs ≤ 90: 1.27 ≥ 65: 15.4 vs 13.9 vs 15.7 (P =.89) HR ≤ 80 vs ≤ 85: 1.11 HR ≤ 80 vs ≤ 90: 0.98 Cardiovascular death: < 65: 2.2 vs 2.9 vs 1.9 (P = .52) HR ≤ 80 vs ≤ 85: 0.76 HR ≤ 80 vs ≤ 90: 1.16 ≥ 65: 8.0 vs 5.7 vs 7.6 (P = .81) HR ≤ 80 vs ≤ 85: 1.40 HR ≤ 80 vs ≤ 90: 1.05 MI: < 65: 2.3 vs 2.9 vs 3.2 (P = .13) HR ≤ 80 vs ≤ 85: 0.79 HR ≤ 80 vs ≤ 90: 0.72 ≥ 65: 3.2 vs 2.4 vs 4.4 (P = .22) HR ≤ 80 vs ≤ 85: 1.33 HR ≤ 80 vs ≤ 90: 0.73 Stroke: < 65: 2.4 vs 3.8 vs 2.3 (P = .77) HR ≤ 80 vs ≤ 85: 0.63 HR ≤ 80 vs ≤ 90: 1.04 ≥ 65: 6.7 vs 6.6 vs 7.8 (P = .41) HR ≤ 80 vs ≤ 85: 1.02 HR ≤ 80 vs ≤ 90: 0.86 |
| JATOS24 SBP < 140 vs < 160 | < 75 (n = 2549) ≥ 75 (n = 1869) | RR (95% CI) P-value for interaction term in Cox regression with treatment, age, sex, and interaction between treatment and age as covariates: Cerebrovascular disease: < 75: 0.65 (0.29 to 1.45) ≥ 75: 1.52 (0.77 to 3.00) P = .03 Cardiovascular disease: < 75: 0.77 (0.26 to 2.25) ≥ 75: 1.07 (0.43 to 2.67) P = .50 Renal failure: < 75: 0.60 (0.09 to 3.91) ≥ 75: 1.25 (0.22 to 7.00) P = .75 |
| SPS339 SBP < 130 vs 130-149 | < 75 (n = 2526) ≥ 75 (n = 494) | HR (95% CI) Total mortality < 75: 1.13 (0.80 to 1.59) ≥ 75: 0.83 (0.53 to 1.29) Vascular death < 75: 1.17 (0.68 to 2.01) ≥ 75: 0.42 (0.18 to 0.98) MI: < 75: 0.91 (0.56 to 1.48) ≥ 75: 0.77 (0.23 to 2.52) Recurrent stroke: < 75: 0.77 (0.59 to 1.01) ≥ 75: 1.01 (0.59 to 1.73) |
| VALISH26 SBP < 140 vs < 150 | < 75 (n = 1233) ≥ 75 (n = 1846) | Combined sudden death; stroke; MI; death due to CHF; other cardiovascular death; unplanned hospitalization for cardiovascular disease; and renal dysfunction, HR (95% CI): < 75: 0.74 (0.35 to 1.56) ≥ 75: 0.95 (0.60 to 1.51) |
| Studies that compared more vs less intensive treatment for hypertension | ||
| ADVANCE27 (Perindopril + indapamide) vs placebo | < 65 (n = 4536) ≥ 65 (n = 6604) | Major macrovascular or microvascular events combined, unadjusted RR (95% CI): < 65: 0.95 (0.82 to 1.09) ≥ 65: 0.90 (0.81 to 1.00) |
| HYVET36 Indapamide vs placebo | 80-84 (n = 2807) ≥ 85 (n = 1038) | HR (95% CI): Total mortality: 80-84: 0.76 (0.60 to 0.97) ≥ 85: 0.88 (0.64 to 1.20) Cardiovascular mortality: 80-84: 0.75 (0.55 to 1.05) ≥ 85: 0.82 (0.53 to 1.32) Cardiac events: 80-84: 0.64 (0.49 to 0.83) ≥ 85: 0.75 (0.50 to 1.12) Stroke: 80-84: 0.70 (0.46 to 1.06) ≥ 85: 0.59 (0.27 to 1.29) |
| SHEP8 Chlorthalidone vs placebo | 60-69 (n = 1963) 70-79 (n = 2124) ≥ 80 (n = 649) | Stroke RR (95% CI): 60-69: 0.74 (0.48 to 1.14) 70-79: 0.65 (0.46 to 0.92) ≥ 80: 0.53 (0.32 to 0.88) |
| Syst-China20 (Nitrendipine ± Captopril ± Hydrochlorothiazide) vs placebo | < 65 (n = 1079) 65-69 (n = 699) ≥ 70 (n = 616) | Unadjusted HR (P-values interpreted from graph): Cardiovascular mortality: < 65: 0.34 (P < .05) 65-69: 0.67 (P = ns) ≥ 70: 0.89 (P = ns) Fatal + nonfatal cardiovascular events: < 65: 0.54 (P < .05) 65-69: 0.80 (P = ns) ≥ 70: 0.62 (P = ns) |
| Syst-Eur40,69 Nitrendipine vs placebo | 60-69 (n = 2501) 70-79 (n = 1753) ≥ 80 (n = 441) | Unadjusted HR (95% CIs not reported; P-values interpreted from graph):69 Total mortality: 60-69: 0.59 (P = ns) 70-79: 0.58 (P < .05) ≥ 80: 1.11 (P = ns) Cardiovascular death: 60-69: 0.58 (P = ns) 70-79: 0.49 (P < .05) ≥ 80: 0.97 (P = ns) Cardiac events: 60-69: 0.64 (P = ns) 70-79: 0.69 (P = ns) ≥ 80: 0.79 (P = ns) Stroke: 60-69: 0.46 (P < .05) 70-79: 0.54 (P < .05) ≥ 80: 0.67 (P = ns) “In Cox regression with adjustment applied for significant covariates, the treatment-by-age interaction term was significant (P = .009) for total mortality and nearly significant (P = .09) for cardiovascular mortality, indicating that the benefit of treatment was lost after the age of about 75 years. In contrast, the treatment-by-age interaction for the combined fatal and nonfatal events was not statistically significant.”40 |
| TRANSCEND35 Telmisartan vs placebo | < 65 (n = 2375) 65-74 (n = 2576) ≥ 75 (n = 975) | Composite outcome of cardiovascular death, myocardial infarction, or stroke: No significant age interaction (P = .80) |
Abbreviations: ACCORD = Action to Control Cardiovascular Risk in Diabetes; ADVANCE = Action in Diabetes and Vascular Disease; C = comparator/control; CHF = congestive heart failure; CI = Confidence interval; DBP = Diastolic blood pressure; HOT = Hypertension Optimal Treatment; HR = hazard ratio; HYVET = Hypertension in the Very Elderly Trial; JATOS = Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients; MI = myocardial infarction; N = Number randomized; ns = not statistically significant; RR = relative risk; SBP = systolic blood pressure; SHEP = Systolic Hypertension in the Elderly Program; SPS3 = Secondary Prevention of Small Subcortical Strokes; Syst-China = Systolic Hypertension in China; Syst-Eur = Systolic Hypertension in Europe; T = treatment; TRANSCEND = Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease; VALISH = Valsartan in Elderly Isolated Systolic Hypertension.
Figure 8Relative risk of mortality in trials of patients with history of stroke
CI = confidence interval; PROGRESS = Perindopril Protection Against Recurrent Stroke Study; SPS3 = Secondary Prevention of Small Subcortical Strokes
Figure 9Relative risk of major cardiac events in trials of patients with history of stroke
CI = confidence interval; PROGRESS = Perindopril Protection Against Recurrent Stroke Study; SPS3 = Secondary Prevention of Small Subcortical Strokes
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