Antihypertensive Agents in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Mohammad Hassan Murad, Laura Larrea-Mantilla, Abdullah Haddad, Gabriela Spencer-Bonilla, Valentina Serrano, Rene Rodriguez-Gutierrez, Neri Alvarez-Villalobos, Khaled Benkhadra, Michael R. Gionfriddo, Larry J. Prokop, Juan P. Brito, Oscar J. Ponce

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1575-1584
Number of pages10
JournalThe Journal of clinical endocrinology and metabolism
Volume104
Issue number5
DOIs
StatePublished - May 1 2019

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    Murad, M. H., Larrea-Mantilla, L., Haddad, A., Spencer-Bonilla, G., Serrano, V., Rodriguez-Gutierrez, R., Alvarez-Villalobos, N., Benkhadra, K., Gionfriddo, M. R., Prokop, L. J., Brito, J. P., & Ponce, O. J. (2019). Antihypertensive Agents in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. The Journal of clinical endocrinology and metabolism, 104(5), 1575-1584. https://doi.org/10.1210/jc.2019-00197