Pharmacotherapy for hypertension in the elderly
Sübutlu məlumatların xülasələri
04.04.2018 • Sonuncu dəyişiklik 04.04.2018
Editors
Treatment of hypertension of elderly persons is highly effective in reducing total mortality, cardiovascular morbidity and mortality and cerebrovascular mortality.
A Cochrane review included 15 RCTs with 24 055 subjects with hypertension . The mean age ranged from 63 to 84 years, the average being 73.8 years. A stepped care approach to hypertension treatment was applied in 12 trials. In over 70% of trials a thiazide diuretic was the first line drug; also beta blockers, calcium blockers were used. Length of study follow- up ranged from 1 to 6 years, a mean duration of treatment was 4.5 years.
- Total mortality was reduced in all patients (RR 0.90; 95% CI 0.84 to 0.97, NNT 84). In very old patients (≥ 80 years) and in 3 trials with isolated systolic hypertension the reduction was not seen (RR 1.01, 95% CI 0.90, 1.13 and RR 0.88, 95% CI 0.77 to 1.01, respectively).
- Total cardiovascular morbidity and mortality was reduced in all patients (RR 0.72; 95% CI 0.68 to 0.77) and in very old patients (RR 0.75; 95% CI 0.65 to 0.87). The reduction was not seen in 3 trials with isolated systolic hypertension (RR 0.88, 95% CI 0.77 to 1.01).
- Cerebrovascular mortality was reduced in all patients (RR 0.66, 95% CI 0.53 to 0.82). The reduction was not seen in very old patients (RR 0.80 95% CI 0.58 to 1.11) or in 3 trials with isolated systolic hypertension (RR 0.68 95% CI 0.42 to 1.11).
- Withdrawals due to adverse effects were increased with treatment (RR 1.71, 95% CI 1.45 to 2.00).
Ədəbiyyat
- Musini VM, Tejani AM, Bassett K, Wright JM. Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev 2009 Oct 7;(4):CD000028.