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- Title
Drug treatment of hypertension in the elderly: a meta-analysis.
- Authors
Insua, Jorge T.; Sacks, Henry S.; Tai-Shing Lau; Lau, Joseph; Reitman, Dinah; Pagano, Daniel; Chalmers, Thomsa C.; Insua, J T; Sacks, H S; Lau, T S; Lau, J; Reitman, D; Pagano, D; Chalmers, T C
- Abstract
<bold>Purpose: </bold>A meta-analysis of the effect of antihypertensive drug treatment on mortality and morbidity in elderly patients.<bold>Data Sources: </bold>A literature search of published articles from January 1980 to February 1992.<bold>Study Selection: </bold>Randomized controlled trials of drug treatment of hypertension with end points for elderly patients reported separately.<bold>Data Extraction: </bold>Mortality or morbidity end points or both in patients older than 59 years were pooled by determination of typical odds ratio. A meta-regression was used to study heterogeneity.<bold>Results: </bold>Nine major trials with 15,559 patients older than 59 years were identified. Death rates in the control group varied between 2.7% and 77.2%; stroke and coronary mortality increased with the severity-of-illness rank (P < 0.001). Overall, treated patients had an approximately 12% reduction in all-cause mortality (odds ratio, 0.88; 95% CI, 0.80 to 0.97; 953 events compared with 1069 events, P = 0.009). There was a 36% reduction in stroke mortality (odds ratio, 0.64; CI, 0.49 to 0.82; 94 events compared with 149 events, P < 0.001) and a 25% reduction in coronary heart disease mortality (odds ratio, 0.75; CI, 0.64 to 0.88; 263 events compared with 350 events, P < 0.001). Coronary morbidity was reduced 15% (odds ratio, 0.85; CI, 0.73 to 0.99; 325 events compared with 379 events, P = 0.036), and stroke morbidity was reduced 35% (odds ratio, 0.65; CI, 0.55 to 0.76; 247 events compared with 382 events, P < 0.001).<bold>Conclusion: </bold>Overall, treatment of hypertension in elderly patients produces a significant benefit in total mortality and cardiovascular morbidity and mortality. However, this benefit may be reduced in the oldest age groups.
- Subjects
MEDICAL care for older people; DRUG efficacy; HYPERTENSION; THERAPEUTICS; CEREBROVASCULAR disease; COMPARATIVE studies; CORONARY disease; RESEARCH methodology; MEDICAL cooperation; META-analysis; RESEARCH; EVALUATION research; SEVERITY of illness index; ODDS ratio; DISEASE complications
- Publication
Annals of Internal Medicine, 1994, Vol 121, Issue 5, p355
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-121-5-199409010-00008