Meta-analysis: BP drugs equally effective in young and old
Clinical QuestionAre different antihypertensives more effective than others in older or younger adults?
Bottom LineThe choice of antihypertensive can be based on factors such as cost, side effect profile, and patient preference, since all antihypertensives are equally effective in decreasing major cardiovascular events. Blood pressure treatment of older patients produces a similar reduction in events as does treatment of younger patients. (LOE = 1a)
ReferenceBlood Pressure Treatment Trialists' Collaboration. Effects of different regimens to lower blood pressure lowering on major cardiovascular events in older and younger patients. Meta-analysis of randomised trials. BMJ 2008;336:1121-1123. [PMID:18480116]
Study DesignMeta-analysis (randomized controlled trials)
SynopsisThere are many theories about the best way to approach patients with hypertension. This meta-analysis sought to clarify whether different drug classes have different effects on preventing major vascular events in patients with hypertension. The authors assembled data on almost 200,000 patients from 31 studies. Few of the studies compared more than one drug against another, so we have the limitation of having to evaluate differences across different studies and different populations. With the exception of alpha-blockers, which were not included in the analysis (the ALLHAT study demonstrated increased morbidity with doxazosin), all classes produced similar reductions in cardiovascular events in both older and younger patients. More intensive control of blood pressure did not produce better outcomes than less intensive control. Specifically, beta-blockers were as effective as other classes, as were calcium channel blockers (drug classes that have recently had their effectiveness questioned, especially in older patients). It would be great if we had one large study comparing a half-dozen or so of the most commonly used antihypertensives, but I don't imagine any of the pharmaceutical companies would support such a project.
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