|Title:||Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis||Authors:||Huang C.-J.
|Keywords:||adverse vascular events; blood pressure; death; effect modification; elderly hypertension; hypertension; meta-analysis||Issue Date:||2019||Publisher:||Oxford University Press||Journal Volume:||32||Journal Issue:||2||Start page/Pages:||163-174||Source:||American Journal of Hypertension||Abstract:||
BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140-150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55-0.85), HF (0.77; 0.60-0.99), cardiovascular death (0.68; 0.52-0.89), and MACE (0.83; 0.69-0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension. ? American Journal of Hypertension, Ltd 2018. All rights reserved.
|ISSN:||0895-7061||DOI:||10.1093/ajh/hpy169||SDG/Keyword:||adverse outcome; aged; antihypertensive therapy; Article; blood pressure; cardiovascular disease; cardiovascular risk; cause of death; cerebrovascular accident; cognition; cognitive defect; creatinine blood level; dementia; dialysis; electrolyte disturbance; end stage renal disease; faintness; fracture; heart failure; heart infarction; human; hypertension; hypotension; ischemic heart disease; kidney failure; kidney transplantation; patient harm; priority journal; quality control; randomized controlled trial (topic); risk factor; side effect; age; aging; drug effect; female; hypertension; male; meta analysis; mortality; pathophysiology; risk assessment; treatment outcome; very elderly; antihypertensive agent; Age Factors; Aged; Aged, 80 and over; Aging; Antihypertensive Agents; Blood Pressure; Female; Humans; Hypertension; Male; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome
|Appears in Collections:||醫學系|
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