Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials

Background Beneficial clinical effects of treatment with antihypertensive d rugs have been shown in middle-aged patients and in those hypertensive pati ents over 60 years old, but whether treatment is beneficial in patients ove r 80 years old is not known. Methods We collected data from all participants aged 80 years and over in r andomised controlled trials of antihypertensive drugs through direct contac t with study investigators. Our primary outcome was fatal and non-fatal str oke. Secondary outcomes were death from all causes, cardiovascular death, f atal and non-fatal major coronary and cardiovascular events, and heart fail ure. Findings There were 57 strokes and 34 deaths among 874 actively treated pat ients, compared with 77 strokes and 28 stroke deaths among 796 controls, re presenting 1 non-fatal stroke prevented for about 100 patients treated each year. The meta-analysis of data from 1670 participants aged 80 years or ol der suggested that treatment prevented 34% (95% CI 8-52) of strokes. Rates of major cardiovascular events and heart failure were significantly decreas ed, by 22% and 39%, respectively. However, there was no treatment benefit f or cardiovascular death, and a non-significant 6% (-5 to 18) relative exces s of death from all causes. Interpretations The inconclusive findings for mortality contrast with the b enefit of treatment for non-fatal events. Results of a large-scale specific trial are needed for definite conclusion that antihypertensive treatment i s beneficial in very elderly hypertensive patients. Meanwhile, an age thres hold beyond which hypertension should not be treated cannot be justified.