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Title: Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis

Abstract

Abstract BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140–150 mm Hg, a lower achieved SBP (<140more » mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55–0.85), HF (0.77; 0.60–0.99), cardiovascular death (0.68; 0.52–0.89), and MACE (0.83; 0.69–0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7]; ORCiD logo [8]
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  1. Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
  3. Institute of Cardiovascular Sciences, University College London (UCL) and National Institute for Health Research (NIHR) UCL Hospitals Biomedical Research Centre, London, UK
  4. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
  5. Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Department of Medicine, National Yang-Ming University, Taipei, Taiwan
  6. Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Faculty Development, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
  7. Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
  8. Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Faculty Development, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
Publication Date:
Sponsoring Org.:
USDOE Office of Electricity (OE), Advanced Grid Research & Development. Power Systems Engineering Research
OSTI Identifier:
1490896
Alternate Identifier(s):
OSTI ID: 1485519
Grant/Contract Number:  
NO1-AG-1-2118
Resource Type:
Published Article
Journal Name:
American Journal of Hypertension
Additional Journal Information:
Journal Name: American Journal of Hypertension Journal Volume: 32 Journal Issue: 2; Journal ID: ISSN 0895-7061
Publisher:
Oxford University Press
Country of Publication:
United States
Language:
English

Citation Formats

Huang, Chi-Jung, Chiang, Chern-En, Williams, Bryan, Kario, Kazuomi, Sung, Shih-Hsien, Chen, Chen-Huan, Wang, Tzung-Dau, and Cheng, Hao-Min. Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis. United States: N. p., 2018. Web. doi:10.1093/ajh/hpy169.
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Huang, Chi-Jung, Chiang, Chern-En, Williams, Bryan, Kario, Kazuomi, Sung, Shih-Hsien, Chen, Chen-Huan, Wang, Tzung-Dau, & Cheng, Hao-Min. Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis. United States. https://doi.org/10.1093/ajh/hpy169
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Huang, Chi-Jung, Chiang, Chern-En, Williams, Bryan, Kario, Kazuomi, Sung, Shih-Hsien, Chen, Chen-Huan, Wang, Tzung-Dau, and Cheng, Hao-Min. Fri . "Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis". United States. https://doi.org/10.1093/ajh/hpy169.
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@article{osti_1490896,
title = {Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis},
author = {Huang, Chi-Jung and Chiang, Chern-En and Williams, Bryan and Kario, Kazuomi and Sung, Shih-Hsien and Chen, Chen-Huan and Wang, Tzung-Dau and Cheng, Hao-Min},
abstractNote = {Abstract BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140–150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55–0.85), HF (0.77; 0.60–0.99), cardiovascular death (0.68; 0.52–0.89), and MACE (0.83; 0.69–0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.},
doi = {10.1093/ajh/hpy169},
journal = {American Journal of Hypertension},
number = 2,
volume = 32,
place = {United States},
year = {Fri Nov 16 00:00:00 EST 2018},
month = {Fri Nov 16 00:00:00 EST 2018}
}
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https://doi.org/10.1093/ajh/hpy169
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