Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials

@article{Gueyffier1999AntihypertensiveDI,
  title={Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials},
  author={François Gueyffier and Christopher John Bulpitt and Jean-Pierre Boissel and Eleanor B. Schron and Tord Ekbom and Robert H. Fagard and Edoardo Casiglia and Karla Kerlikowske and J. A. R. Coope},
  journal={The Lancet},
  year={1999},
  volume={353},
  pages={793-796}
}
Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials
TLDR
Treating hypertension in very old patients reduces stroke and heart failure with no effect on total mortality with the most reasonable strategy associated with significant mortality reduction; thiazides as first-line drugs with a maximum of two drugs.
Protective effects of antihypertensive treatment in patients aged 85 years or older
TLDR
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TLDR
Treating healthy subjects aged 75 years and older with moderate to severe hypertension reduces non-fatal strokes, cardiovascular morbidity and mortality and the incidence of heart failure but does not change total mortality.
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TLDR
The quality of evidence for all outcomes was downgraded and very low quality evidence from three studies showed that withdrawals due to adverse events were higher with drug therapy than with placebo or untreated control.
Hypertension in the very elderly: Brief review of management.
TLDR
Data from clinical trials including HYVET favor thiazide diuretics, angiotensin converting enzyme inhibitors and calcium channel blockers for either mono-therapy or combination therapy for hypertension in the elderly, a very powerful and rapidly growing subpopulation of patients.
Pharmacotherapy for hypertension in the elderly.
TLDR
Treating healthy persons (60 years or older) with moderate to severe systolic and/or diastolic hypertension reduces all cause mortality and cardiovascular morbidity and mortality.
Is it Time for a Cardiovascular Primary Prevention Trial in the Elderly?
TLDR
A 5-year 2×2 factorial trial of primary prevention in the elderly is proposed that will evaluate whether statin therapy will reduce the risk of cardiovascular events when added to the treatment of hypertension to achieve a blood pressure <140/90 mm Hg in most patients and determine the most appropriate blood pressure regimen for the prevention of cardiovascular and renal events.
Efficacy and safety of routine blood pressure lowering in older patients with diabetes: results from the ADVANCE trial
TLDR
Routine administration of perindopril–indapamide lowers blood pressure safely and reduces the risk of major clinical outcomes in patients of at least 75 years with type 2 diabetes.
Anti-Hypertensive Medications and Cardiovascular Events in Older Adults with Multiple Chronic Conditions
TLDR
In this nationally representative cohort of older adults, anti-hypertensive treatment was associated with reduced mortality but not cardiovascular events, and results were similar in the propensity score-matched subcohort.
Benefits and risks of antihypertensive medications in the elderly
TLDR
The purpose of this review was to provide a comprehensive summary of the benefits and risks of the use of antihypertensive drugs in elderly patients (aged ≥65 years), highlighting landmark clinical trials and observational studies.
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A randomised trial of the treatment of hypertension in 884 patients aged 60 to 79 years at the onset showed a reduction of 18/11 mm Hg in blood pressure over a mean follow up period of 4.4 years. The
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TLDR
Randomized trials demonstrate that treating healthy older persons with hypertension is highly efficacious, and five-year morbidity and mortality benefits derived from trials are greater for older than younger subjects.
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Overall and cardiovascular annual cumulative mortality were significantly lower in the >> special therapy >> than in the << free therapy >> group, and the fixed combination of atenolol and chlorthalidone reduced mortality below that of the normotensives, independent of other cardiovascular risk factors.
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It is suggested that antihypertensive treatment was effective in the aged with mild hypertension, and that careful follow up was needed not only for cardiovascular complications but also for general health condition.
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TLDR
Differences between groups were significant for systolic and diastolic blood pressure but not for death or stroke rates, and a full-scale study has begun to determine the effects of drug therapy for isolated syStolic hypertension on stroke and mortality rates.
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TLDR
Although the event rates were greater for patients with previous cardiovascular events and patients over the age of 70 years, the percentage reduction in cardiovascular events was similar in these groups to those without complications and in patients between 60 and 69 years of age.
New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit.
TLDR
The most constant treatment benefit concerned stroke, although the absolute reduction was very modest in younger patients with mild-to-moderate hypertension, and a trend towards greater absolute benefit under treatment was indicated.
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