Intervention Review

Pharmacotherapy for hypertension in the elderly

  1. Vijaya M Musini1,*,
  2. Aaron M Tejani2,
  3. Ken Bassett1,
  4. James M Wright1

Editorial Group: Cochrane Hypertension Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 31 MAY 2009

DOI: 10.1002/14651858.CD000028.pub2


How to Cite

Musini VM, Tejani AM, Bassett K, Wright JM. Pharmacotherapy for hypertension in the elderly. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000028. DOI: 10.1002/14651858.CD000028.pub2.

Author Information

  1. 1

    University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada

  2. 2

    Fraser Health Authority, Pharmacy Services, Burnaby, BC, Canada

*Vijaya M Musini, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, V6T 1Z3, Canada. vijaya@ti.ubc.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

Elevated blood pressure (known as hypertension) increases with age, and most rapidly over age 60.  Systolic hypertension is more strongly associated with cardiovascular disease than diastolic hypertension, and occurs more commonly in older people.  It is important to know the benefits and harms of antihypertensive treatment of hypertension in this age group.

Objectives

To quantify antihypertensive drug effect on overall mortality, cardiovascular mortality and morbidity and withdrawal due to adverse effects in people 60 years and older with mild to moderate systolic or diastolic hypertension.

Search methods

Updated search of electronic database of EMBASE, CENTRAL, MEDLINE until Dec 2008; previous search of two Japanese databases (1973-1995) and WHO-ISH Collaboration register (August 1997); references from reviews, trials and previously published meta-analyses; and experts.

Selection criteria

Randomized controlled trials of at least one year duration in hypertensive elders (at least 60 years old) comparing antihypertensive drug therapy with placebo or no treatment and providing morbidity and mortality data.

Data collection and analysis

Outcomes assessed were total mortality (including cardiovascular, coronary heart disease and cerebrovascular mortality); total cardiovascular morbidity and mortality (representing combined coronary heart disease and cerebrovascular morbidity and mortality); and withdrawal due to adverse events.

Main results

Fifteen trials (24,055 subjects ≥ 60 years) with moderate to severe hypertension were identified.  These trials mostly evaluated first-line thiazide diuretic therapy for a mean duration of treatment of 4.5 years. Treatment reduced total mortality, RR 0.90 (0.84, 0.97); event rates per 1000 participants reduced from 116 to 104.  Treatment also reduced total cardiovascular morbidity and mortality, RR 0.72 (0.68, 0.77); event rates per 1000 participants reduced from 149 to 106. In the three trials restricted to persons with isolated systolic hypertension the benefit was similar. In very elderly patients ≥ 80 years the reduction in total cardiovascular mortality and morbidity was similar RR 0.75 [0.65, 0.87] however, there was no reduction in total mortality, RR 1.01 [0.90, 1.13].  Withdrawals due to adverse effects were increased with treatment, RR 1.71 [1.45, 2.00].

Authors' conclusions

Treating healthy persons (60 years or older) with moderate to severe systolic and/or diastolic hypertension reduces all cause mortality and cardiovascular morbidity and mortality. The decrease in all cause mortality was limited to persons 60 to 80 years of age.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Blood pressure lowering drugs reduce stroke and heart attack in elderly people with hypertension

Hypertension (high blood pressure) is common among elderly people and increases the risk of heart attack and stroke. An assessment of all the trials of blood pressure lowering therapy in people with hypertension 60 years and over showed that treatment reduced death, strokes and heart attacks. The benefit was similar if both the upper and lower number was elevated or only the upper number. In people 80 and over treatment did not reduce death but did reduce stroke.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

高血壓藥物治療對老年病患之影響

研究背景

老年病患與年輕病患或中年病患相較,有較高的高血壓盛行率。而老年的高血壓病患也比中年高血壓病患有較高的心血管疾病罹病率或死亡率。雖然老年人有較高的高血壓盛行率及風險,但是大部分早期的隨機控制臨床試驗只評估高血壓藥物對中年病患的影響。然而,自從1985年起,大型的相關試驗已經陸陸續續被發表,也有許多的統合分析(metaanalysis)統合這些大型試驗的回溯討論(Davidson 1987, Staessen 1988, Staessen 1990a, Staessen 1990b, Leonetti 1992, Thijs 1992, Celis 1993, MacMahon 1993, Thijs 1994, Pearce 1995)。這一篇回顧性文章的目的即在於根據這些大型試驗及統合分析的證據來探討長期高血壓藥物治療對老年病患的利與弊。

研究目的

將高血壓藥物對老年病患的長期罹病率及死亡率量化,並探討試驗參加者共病性之 風險概況。

检索方法

由網路搜尋:WHOISH Collaboration register (1997年8月), The Cochrane Library (1997年; Issue 1), MEDLINE (1966年至1997年4月)以及兩個日本資料庫 (1973年至1995年)。從中找尋回溯討論的參考文章,臨床試驗,十篇已發表的統合分析法,以及專家意見。

纳入标准

研究高血壓控制藥物的治療對老年病患(大於60歲)之影響的隨機臨床控制試驗,研究時間必須大於一年以上,且需提供罹病率及致死率數據

数据收集与分析

至少兩名獨立的審查者摘要出試驗的特性與(罹病率及死亡率)結果,分析結果包括:總死亡率,冠狀動脈心臟疾病的死亡率,冠狀動脈心臟疾病的總和罹病率及死亡率,腦血管疾病的死亡率,腦血管疾病的總和罹病率及死亡率,心血管疾病的死亡率,心血管疾病的總和罹病率及死亡率,以及因為藥物副作用退出試驗。

主要结果

共收錄15份臨床試驗,包括了21,908名老年病患。參與臨床試驗的老年病患,其心血管疾病風險因子,心血管疾病以及其他疾病的平均發生率皆較一般的老年病患為低。大部分的受試者年齡介於60到80歲之間。大部份的臨床試驗是在西方的工業化國家中進行。主要的治療藥物為利尿劑及乙型腎上腺素受體拮抗劑。就每1000名受試者在5年間發生疾病的機率來說,高血壓藥物確實是有益的。心血管疾病的罹病率及死亡率從177件減少至126件(95%信賴區間的差異為31至73)。心血管疾病的死亡率從69件減少至50件(95%信賴區間的差異為9至31)。總死亡率由129件減少至111件(95%信賴區間的差異為4至28)。探討其中3個針對單純高收縮壓老年病患的臨床試驗,可發現高血壓藥物治療帶來明顯的好處。每1000名老年病患的心血管疾病五年發生率及死亡率由157件減少至104件(95%信賴區間的差異為12至89)。因為高血壓藥物的副作用而罹病率試驗人數往往沒有被提及。而在提到因副作用而人數的四篇臨床試驗中,則顯現了共有4個試驗呈現了該數據,其在退出率呈現了相當的差異,範圍由控制組與對照組間退出率沒有顯著差異到有4/1的病人因副作用而退出。

作者结论

已有多篇的隨機臨床控制試驗證實了降血壓藥物對單純罹患高血壓的健康老年病患有明顯的益處。低劑量的利尿劑或乙型腎上腺素拮抗劑對於60到70歲的治療高血壓病患(無論是高收縮壓或高舒張壓)都有益處。但對於不同的高血壓病患族群間(不同的風險因子,已知罹患心血管疾病,已知罹患其他疾病),則目前已發表的臨床試驗無法比較高血壓治療的益處。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

高血壓藥物治療對老年病患之影響

老年病患使用高血壓藥物能有效的預防嚴重的高血壓併發症,例如中風或心臟病。 高血壓是老年族群常見的疾病,而且會增加嚴重問題的風險,如:中風及心臟病的風險。已有許多藥物能夠降低血壓,進而減少罹患這些高血壓併發症的風險,但針對大於60歲的老年高血壓病患的血壓控制所做的研究仍然是比較缺乏的。這篇回顧性文章發現老年病患使用高血壓藥物以降低血壓能有效的預防嚴重的高血壓併發症,例如中風或心臟病。然而,針對更為年長的病患或是有其他疾病的病患(例如糖尿病)而言,高血壓藥物的治療效果則需要更進一步的研究。

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