Mohammad Hassan Murad1, Laura Larrea-Mantilla1, Abdullah Haddad1,2, Gabriela Spencer-Bonilla1, Valentina Serrano1,3, Rene Rodriguez-Gutierrez1,4, Neri Alvarez-Villalobos1,4, Khaled Benkhadra1, Michael R Gionfriddo5, Larry J Prokop1, Juan P Brito1,6, Oscar J Ponce1,7. 1. Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota. 2. Section of Cardiology, Temple University-Lewis Katz School of Medicine, Philadelphia, Pennsylvania. 3. Department of Nutrition, Diabetes and Metabolism, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 4. Plataforma INVEST Medicina UANL-KER Unit (KER Unit México), Subdireccion de Investigacion, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México. 5. Center for Pharmacy Innovation and Outcomes, Geisinger Health System, Forty Fort, Pennsylvania. 6. Division of Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic, Rochester, Minnesota. 7. Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru.
Abstract
BACKGROUND: This systematic review summarizes the benefits of treating blood pressure (BP) in individuals 65 years and older. METHODS: We included randomized trials that evaluated BP-lowering medications or BP targets in individuals 65 years and older. Trials were selected and appraised by pairs of independent reviewers. RESULTS: We included 19 trials (42,134 patients). In individuals 65 years or older, antihypertensive therapy was associated with a reduction in all-cause mortality [relative risk: 0.88 (95% CI: 0.81 to 0.94); high certainty evidence; mean follow-up 31 months], cardiovascular mortality, myocardial infarction, heart failure, stroke, and chronic kidney disease. Individuals 75 years or older had a significant reduction in the risk of all-cause and cardiovascular mortality, stroke, and heart failure. Strict systolic BP targets (<120 mm Hg and <130 mm Hg) were associated with a significant reduction in the risk of all-cause and cardiovascular mortality and heart failure, whereas more liberal systolic targets (<150 mm Hg and <160 mm Hg) were associated with lower risk of heart failure and stroke. Older adults with type 2 diabetes mellitus (DM) had lower risk of chronic kidney disease without a significant reduction in other outcomes. However, there was no significant difference in estimates (i.e., interaction) between those with and without DM. CONCLUSIONS: Individuals aged 65 years and older or 75 years and older who receive antihypertensive therapy have statistically significant reduction in the risk of all-cause and cardiovascular mortality, heart failure, and stroke. There was no statistically significant difference in estimates between those with and without DM.
BACKGROUND: This systematic review summarizes the benefits of treating blood pressure (BP) in individuals 65 years and older. METHODS: We included randomized trials that evaluated BP-lowering medications or BP targets in individuals 65 years and older. Trials were selected and appraised by pairs of independent reviewers. RESULTS: We included 19 trials (42,134 patients). In individuals 65 years or older, antihypertensive therapy was associated with a reduction in all-cause mortality [relative risk: 0.88 (95% CI: 0.81 to 0.94); high certainty evidence; mean follow-up 31 months], cardiovascular mortality, myocardial infarction, heart failure, stroke, and chronic kidney disease. Individuals 75 years or older had a significant reduction in the risk of all-cause and cardiovascular mortality, stroke, and heart failure. Strict systolic BP targets (<120 mm Hg and <130 mm Hg) were associated with a significant reduction in the risk of all-cause and cardiovascular mortality and heart failure, whereas more liberal systolic targets (<150 mm Hg and <160 mm Hg) were associated with lower risk of heart failure and stroke. Older adults with type 2 diabetes mellitus (DM) had lower risk of chronic kidney disease without a significant reduction in other outcomes. However, there was no significant difference in estimates (i.e., interaction) between those with and without DM. CONCLUSIONS: Individuals aged 65 years and older or 75 years and older who receive antihypertensive therapy have statistically significant reduction in the risk of all-cause and cardiovascular mortality, heart failure, and stroke. There was no statistically significant difference in estimates between those with and without DM.
Authors: Swetta A Jansen; Bas Huiskens; Stella Trompet; JWouter Jukema; Simon P Mooijaart; Ko Willems van Dijk; Diana van Heemst; Raymond Noordam Journal: Geroscience Date: 2021-12-21 Impact factor: 7.581
Authors: William J Kostis; Javier Cabrera; Chun Pang Lin; John B Kostis; Jennifer Wellings; Stavros Zinonos; Jeanne M Dobrzynski; Daniel Blickstein Journal: Int J Cardiol Hypertens Date: 2020-09-19
Authors: Jonathan M K Bogaerts; Leonie M von Ballmoos; Wilco P Achterberg; Jacobijn Gussekloo; Sven Streit; Milly A van der Ploeg; Yvonne M Drewes; Rosalinde K E Poortvliet Journal: Age Ageing Date: 2022-01-06 Impact factor: 10.668