Hypertension: treating elderly patients reduces cardiovascular events

Clinical bottom line (level 1a)

  1. Elderly patients with hypertension who take antihypertensive medication are less likely to have cardiovascular events (NNT = 18 at 5 years) .
Mulrow et al: Journal of the American Medical Association 1994; 272 (24): 1932-1938
Expires February 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: aged > 65 with hypertension
  • Intervention: antihypertensive medication
  • Outcome: cardiovascular event


    • Articles found in English using Medline, 1966 to 1993 (search terms: hypertension, elderly or aged or geriatric and morbidity or mortality or randomized controlled trials ) and searching reference lists of retrieved articles

    Selection criteria: by 2 independent reviewers: detailed in text
    Appraisal criteria: blinding, drop-out rates, intention-to-treat
    Articles excluded if:
    • study lasted < 1 year
    • patients aged < 60


    13 studies found - 6 were high quality.
    No significant heterogeneity was noted.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    cardiovascular event 5 years /
    (%)
    ( to )     		18
    (14 to 25)
    cerebrovascular event 5 years /
    (%)
    ( to )     		43
    (31 to 69)
    coronary heart disease event 5 years /
    (%)
    ( to )     		61
    (39 to 141)

    • The majority of patients were taking either beta-blockers or diuretics.
    • No odds ratios were reported, only numbers-needed-to-treat.

    Comments

    1. There are only studies in elderly <85 years of age, and at the moment it is not certain that we can extrapolate the results to the very elderly.
    2. Two to four times more young patients need to be treated compared with elderly patients to prevent one cardiovascular event.
    3. The hypertensive elderly at large differ in several respects and the application of trial results from relatively healthy elderly to, for example, frail elderly may be difficult.

    Citation

    1. Mulrow CD, Cornell JA, Herrera CR, et al: hypertension in the elderly; implications and generalizability of randomized trials. Journal of the American Medical Association 1994; 272 (24): 1932-1938
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: Timo Strandberg

    Clinical Question.
    Patient elderly with hypertension
    Intervention or Exposure antihypertensive medication
    Outcome cardiovascular events