Antihypertensive therapy and improved life expectancy without cerebrovascular accident and without coronary artery disease

The absolute benefit from antihypertensive therapy increases with the basel ine risk. However, age is a major determinant of cardiovascular risk, so it is important to express therapeutic efficacy with indices for which age is not a confounder. With this aim we explored the expected gain in life expe ctancy without cardiovascular events according to age at the initiation of the treatment. The treatment effect estimated from the INDANA meta-analysis, was applied t o the cardiovascular risk of a French hypertensive population, simulated fr om national vital statistics. The gain in life expectancy was estimated fro m the area between survival curves without events. The treatment effect var ied according three different hypotheses: increasing, decreasing or constan t effect. When assuming a constant treatment effect, our results show a 29 month gain without stroke for a man who began his treatment at 40 years, and 15 month s if hypertension is screened and treatment initiated at 75 years. The gain s without coronary heart disease are respectively of 11 and 6 months. The v ariation of treatment effect over time could have a major impact on the tre atment benefit. The gain in life expectancy without events is a relevant decision tool, com pleting usefully the absolute benefit, since it takes into account the infl uence of age.