Antihypertensive Therapy Reduces Cardiovascular Events, Strokes, and Mortality in Older Adults
Antihypertensive therapy reduces the risk of cardiovascular (CV) events, strokes, and mortality in older adults with hypertension, researchers reported. The findings suggest that antihypertensive drugs should be considered in all patients over age 65 with hypertension.
“Over the past few decades, a number of randomized trials and meta‑analyses have supported the benefits of antihypertensive medication in reducing the incidence of cardiovascular disease (CVD) among hypertensive patients over the age of 65 years. However, these studies were not designed to identify the appropriate target blood pressure in this population,” said Maciej Ostrowski, at Medical University of Lodz, Poland.
“There is also still a large debate on the optimal target blood pressure level for older adults with hypertension, especially concerning whether systolic blood pressure reduction below 140 mm Hg is beneficial and safe,” he added. “Experts have emphasized that very limited data exist to make definitive recommendations on how low we should reduce blood pressure in older patients, and that data are lacking on the effects of hypertensive therapy in this group of patients.”
The aim of the current meta-analysis was to investigate the effect of hypertension therapy on blood pressure and CV and mortality outcomes in patients over the age of 65. The safety of blood pressure lowering in older adults was also analyzed. The study was performed within the Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group.
The researchers looked at data published between 1966 and 2013 on Scopus, PubMed, Web of Science, and the Cochrane Central Register of randomized controlled trials for appropriate studies. They included 11 randomized controlled trials with 40,325 older patients with hypertension randomized to receive either antihypertensive drugs or placebo.
The investigators found that blood pressure lowering therapy was associated with a significant reduction in systolic blood pressure (–12.43 mm Hg) and diastolic blood pressure (–5.06 mm Hg). It was also associated with a significant reduction in all-cause mortality rate of 13% (relative risk [RR] 0.87), reduction in the risk of death from all-cardiac causes of 18% (0.82), reduction in CV events of 21% (0.79), and reduction in stroke of 30% (0.70), including reduction in fatal stroke of 39% (0.61).
There was no significant relation between blood pressure lowering in older adults and the risk of hospitalizations resulting from angina pectoris (RR 1.13) or heart failure (0.95). An association between blood pressure lowering and the risk of falls was observed, however (1.21).
“Antihypertensive therapy in older adults is very effective and should be considered in all patients over 65 years of age with hypertension, as it significantly reduces the risk of CV events, strokes, and mortality,” said Dr. Ostrowski. All patients should be made aware of the large benefits of this therapy.”
“There are still very limited data on possible complications associated with blood pressure lowering in this group of patients, especially the risk of falls, which needs to be investigated further,” he added. “Therefore, physicians must remember that in older patients, blood pressure therapy should be individualized, with blood pressure goals adapted to individual tolerability. Within the LBPMC Group, we are now conducting a second meta-analysis to answer the question of optimal blood pressure goals in older adults.”
Permanent AF Doubles Risk of Stroke, Compared With Paroxysmal AF
Permanent atrial fibrillation (AF) doubles the risk of stroke, compared with paroxysmal AF, according to a study of more than 6,000 patients. The findings suggest that a simple clinical assessment of the type of AF can help physicians to better estimate stroke risk.
Ischemic stroke is the second leading cause of death in the European Union. It accounts for more than one million deaths and many more disabled patients each year. Annual direct health care costs amount to more than €20 billion. The presentation of AF can vary from short and often self-limiting episodes of arrhythmia in people with otherwise normal heart rhythm (ie, paroxysmal AF) to a continuously abnormal rhythm called permanent AF.
“Our study shows that the risk of stroke is higher in patients in whom the arrhythmia is present permanently, compared to patients who only have short episodes of arrhythmia, even when correcting for other stroke risk factors,” said Thomas Vanassche, MD, PhD, Clinical Research Fellow at the Population Health Research Institute, McMaster University, in Hamilton, Canada. “Although it may seem intuitive that the continuous presence of AF carries a higher stroke risk than short, intermittent episodes, this has been an area of controversy.
“Although some recent trials have reported higher stroke rates in patients with permanent, compared with paroxysmal AF, other studies did not report a significant difference,” he added. “Current guidelines recommend that the pattern of AF should not be taken into account when assessing the stroke risk in patients with AF, suggesting that, when it comes to stroke risk, any AF is AF.”