Table 5. Review of studies on hypertension in the elderly.
| Studies | Quality assessment | Summary of findings | Quality | |||||||||
| Ref | N | Study design | Limitations | Inconsistency | Indirectness | Imprecision | Publication bias | Relative effect estimates | Absolute effect estimates | |||
| ACEI: Angiotensin-converting enzyme inhibitors; ARBs: Angiotensin II receptor blockers; ARR: absolute risk reduction; BS: Blind Study; BQ: beta-blockers; CA-ANTAG: calcium antagonist; CI: confidence interval; CS: cohort study; D: diuretic; DWA: difference in weighted averages; DBP: dyastolic blood pressure;eGFR: estimated glomerular filtration rate; FI: frailty index ; HR: Hazard ratio; I: Important; m: men; NA: Not Applicable; NNTB: number needed to treat for an additional beneficial outcome; ns: not significant; OBS: observational study; OR: odds ratio; PBO: placebo group; RCT: random clinical trial; Ref: bibliography reference annex 1; RR: relative risk; s: second; SAEs: serious adverse events ;SBP: systolic blood pressure;SR: systematic review; UV: unavailable; U: Untected ; VI: very Important;vs: versus; w: women. | ||||||||||||
| Which is the impact of hypertension in the overall mortality in the elderly? | ||||||||||||
| 48 | 8 221 (4 120 with treatment) (SBP < 140 mm Hg and DBP < 90 mm Hg) |
SR | VI | I | U | I | U | RR 1.24 (CI 0.99-1.54) | 31/1000 (low SBP) 39/1000 (CI95% 31-48) |
Low | ||
| 49 | > 33 600 4 120 with treatment (SBP 130 mm Hg -140 mm Hg) |
SR |
I | I | U | U | U | RR 0.82 (CI 0.50-1.36) |
UV | Moderate | ||
| 50 | 2 636 1 317 with treatment (SBP < 12 mm Hg) 440 with treatment (FI > 0.21) 371 with treatment (walking speed < 0.8/s) |
RCT | I | I | U | U | U | HR 0.67 (0.49-0.91) (intensive treatment) HR 0.64 (0.41-1.01) p=0.05 (in frail patients) HR 0.75 (0.44-1.26) (in walking speed) |
1.78% events/year (CI95% 1.41-2.24) (intensive treatment) vs 2.63% events/year (CI 95% 2.17-3.18) (standard treatment) |
High | ||
| 51 | 96 549 18 139 (N < 140 mm Hg) 11 899 (N > 65years ≥ 140 mm Hg SBP) |
SR | I | I | U | I | U | RR 0.95 (0.81-1.11) ( > 65 years SBP≥140 mm Hg) RR 0.73 (0.52-1.02) (SBP < 140 mm Hg) |
UV | Moderate | ||
| 52 | 1167 586 with treatment (SBP < 120 mm Hg) |
RCT | VI | I | I | I | U | HR 0.67 (0.49-0.92) (intensive treatment) | Cumulative incidence events/year (3.75years): 0.11 (intensive treatment) vs 0.15 (standard treatment) | Moderate- low | ||
| 53 | 21 906 | SR OBS | VI | I | I | I | U | HR 1.02 (0.90-1.16) (SBP < 140 mm Hg /frail) HR 0.86 (0.77-0.96) (SBP < 140 mm Hg / non-frail) HR 1.01 (0.69-1.46) (DBP < 90 mm Hg /frail) HR 0.90 (0.76-1.07) (DBP < 90 mm Hg / non frail) |
UV | Moderate- low | ||
| Which is the impact of hypertension on stroke in the elderly? | ||||||||||||
| 48 | 8 221 4 120 with treatment (SBP < 140 mm Hg and DBP < 90 mm Hg) |
SR | VI | I | U | I | U | RR 1.25 (CI 0.94-1.67) | 20 /1000 (low SBP) 25 /1000 (CI95%: 19 a 33) (high SBP) |
Low | ||
| 50 | 2 636 1 317 with treatment (SBP < 120 mm Hg) 440 with treatment (FI > 0.21 mm Hg) 371 with treatment (walking speed < 0.8/s) |
RCT | I | I | U | U | U | HR 0.72 (0.43-1.21) | 0.67% events/year (CI95% 0.46-0.97) (intensive treatment) vs 0.85% events/year (CI 95% 0.61-1.19) (standard treatment) |
High | ||
| 51 | 96 549 18 139 with treatment (SBP < 140 mm Hg) 11 899 with treatment ( > 65years SBP≥140 mm Hg) |
SR | I | I | U | I | U | RR 0.70 (0.60-0.83) ( > 65 years SBP≥140 mm Hg) RR 0.65 (0.49-0.86) (SBP < 140 mm Hg) |
UV | Moderate | ||
| Which is the impact of hypertension on serious adverse events in the elderly? | ||||||||||||
| 48 | 8 221 4 120 with treatment (SBP < 140 mm Hg Y DBP < 90 mm Hg) |
SR | VI | I | U | I | U | RR 1.95 (CI 0.98-1.45) |
42/1000 (low SBP) 50/1000 (Ci95%: 41 a 61) (high SBP) |
Low | ||
| 50 | 2 636 1 317 with treatment (SBP < 120 mm Hg) 440 with treatment (FI > 0.21) 371 with treatment (walking speed < 0.8/s) |
RCT | I | I | U | U | U | HR 0.66 (0.51-0.85) (intensive treatment) HR 0.68 (0.45-1.01) p=0.06 (frail) HR 0.63 (0.40-0.99) p=0.05 (walking speed) |
2.59% events/year (CI95% 2.13-3.14) (intensive treatment) vs 3.85% events/year (CI 95% 3.28-4.53) (standard treatment) |
High | ||
| 51 | 96 549 6 779 with treatment ( > 65years SBP≥140 mm Hg) 21 042 with treatment (SBP < 140 mm Hg) |
SR | I | I | U | I | U | RR 0.78 (0.70-0.86) ( > 65 years SBP≥140 mm Hg) RR 0.75 (0.62-0.89) (SBP < 140 mm Hg) |
UV | Moderate | ||
| 52 | 1 167 586 with treatment (SBP < 120 mm Hg) |
RCT |
VI | I | I | I | U | HR 0.67 (0.50-0.90) (intensive treatment) | Cumulative incidence (3.61/year): 0.13 (intensive treatment) vs 0.18 (standard treatment) | Moderate- low | ||
| Which is the impact of hypertension on acute myocardial infarction in the elderly? | ||||||||||||
| 49 | > 33 600 4 120 with treatment (SBP 130 mm Hg -104 mm Hg) |
SR | I | I | U | U | U | RR 1.04 (CI 0.57-1.89) | UV | Moderate | ||
| 50 | 2 636 1 317 with treatment (SBP < 120 mm Hg) |
RCT | I | I | U | U | U | HR 0.69 (0.45-1.05) | 0.92% events/year (CI 95% 0.67-1.27) (intensive treatment) vs 1.34% events/year (Ci 95% 1.02-1.75) (standard treatment) |
High | ||
| 51 | 96 549 21 042 with treatment ( > 65years SBP≥140 mm Hg) 17 785 with treatment (SBP < 140 mm Hg) |
SR | I | I | U | I | U | RR 0.84 (0.73-0.99) ( > 65 years SBP≥140 mm Hg) RR 0.69 (0.47-1.02) (SBP < 140 mm Hg) |
UV | Moderate | ||
| Which is the impact of hypertension on cardiovascular mortality in the elderly? | ||||||||||||
| 48 | 8 221 4 120 with treatment (SBP < 140 mm Hg Y DBP < 90 mm Hg) |
SR | VI | I | U | I | U | RR 1.52 (CI 1.06-2.19) |
17 por 1000 (low SBP) 14 por 1000 (high SBP) |
Low | ||
| 49 | > 33 600 4 120 with treatment (SBP 130 mm Hg -140 mm Hg) |
SR | I | I | U | U | U | RR 0.75 (CI 0.41-1.39) |
UV | Moderate | ||
| 50 | 2 636 1 317 with treatment (SBP < 120 mm Hg) |
RCT | I | I | U | U | U | HR 0.60 (0.33-1.09) | 0.44% events/year (CI95% 0.28-0.70) (intensive treatment) vs 0.72% events/year (CI 95% 0.50-1.03) (standard treatment) |
High | ||
| 51 | 96 549 with treatment ( > 65years SBP ≥ 140 mm Hg) 17 785 with treatment (SBP < 140 mm Hg) |
SR | I | I | U | I | U | RR 0.84 (0.67-1.06) ( > 65 years SBP≥140 mm Hg) RR 0.62 (0.38-1.02) ns (SBP < 140 mm Hg) |
UV | Moderate | ||
| Is a higher withdrawal rate due to adverse effects in the elderly? | ||||||||||||
| 48 | 8 221 4 120 with treatment (SBP < 140 mm Hg Y DBP < 90 mm Hg) |
SR | VI | I | U | I | U | RR 0.83 (CI 0.58-1.19) | 17 por 1000 (low SBP) 14 por 1000 (CI95%: 10 a 20) (high SBP) |
Low | ||
| Which is the withdrawal rate due to adverse effects in the elderly? | ||||||||||||
| 50 | 2 636 1 317 with treatment (SBP < 120 mm Hg) |
RCT | I | I | U | U | U | HR 0.99 (0.89-1.11) | SAEs 48.4% (N 637) (intensive treatment) SAESs 48.3% (N 637) (standard treatment) |
High | ||
| 51 | 96 549 7 465 with treatment ( > 65years SBP≥140 mm Hg) 17 331 with treatment (SBP < 140 mm Hg) |
SR | I | I | U | I | U | RR 2.18 (0.73-6.54) ( > 65 years SBP≥140 mm Hg) RR 1.55 (1.21-1.95) (SBP < 140 mm Hg) |
UV | Moderate | ||
| 52 | 1 167 586 with treatment (SBP < 120 mm Hg) |
RCT | VI | I | I | I | U | HR +0.92 (0.79–1.07) (SAEs) HR 3.41 (1.92–6.06) (- 30% eGFR) HR 2.12 (95% CI 1.37–3.26) (kidney failure) |
SAES cumulative incidence (3.76 year): 0.60 (intensive treatment) vs 0.61 (standard treatment) Cumulative incidence of acute kidney failure (3.57 YEAR): 0.10 (intensive treatment) vs 0.05 (standard treatment) |
Moderate- low | ||
| What pharmarcological options for hypertension are available to improve overall mortality in the elderly? | ||||||||||||
| 54 | 26 795 13 368 with treatment |
SR | VI | U | U | U | U | RR 0.91 (0.85-0.97) ( > 60 years) RR 0.86 (0.79-0.95) 60-79 years) RR 0.87 (0.87-1.10) ( > 80 years) |
81 per 1000 (CI95% 75-90) (active) vs 95 per 1000 (control) (60-79 a) ARR 1.4%; NNTB 72 138 per 1000 (CI95% 124-157) (active) 142 per 1000 (N C) ARR ns; NNTB ns |
Moderate- High |
||
| 51 |
96 549 30 059 with treatment ( > 65years) 3 070 with treatment ( > 80years) |
SR CS | I | I | U | I | U | RR 0.87 (0.76-0.99) ( > 65 years) RR 0.98 (0.85-1.14) ( > 80 years) |
-16/1000 patientss/5 years ( > 65 a) -7/1000 patiens/5 years ( > 80 a) |
Moderate | ||
| 55 | 4 396 6 290 with treatment/year 6 330 with treatment BQ/year |
BS RCT | I | U | U | U | U | Difference (%): 3% (-14 a 18) (Active vs PBO) 16% (-5 to 33) (D vs PBO) 8% (-34 to 12) (BQ vs PBO) |
Absolute difference (1000 patients/year): 0.8 (-3.0 a 4.6) (treatment vs PBO) |
High | ||
| 56 | 3 845 1 933 with treatment |
RCT | U | U | U | U | U | HR non ajusted 0.79 (0.65-0.95) p=0.02 | SBP/1000 patients/year (no events): 47.2 (196) (treatment) vs 59.6 (235) (PBO) |
High | ||
| 57 | 55 645-94 228 19 942 with treatment D 7 937 with treatment BQ 23 362 with treatment CA-ANTAG 15 742 with treatment ACE 6 222 with treatment ARBs |
SR CS | I | I | U | I | U | RR 1.00 (0.94-1.06) (D vs others) RR 1.14 (1.04-1.25) (BQ vs others) RR 0.94 (0.91-0.98) (CA-ANTAG vs others) RR 1.04 (0.99-1.08) (ACE vs others) |
UV | High | ||
| What pharmacological options for hypertension are available to improve cardiovascular mortality in the elderly? | ||||||||||||
| 51 | 96 549 30 299 with treatment ( > 65years) 3 010 with treatment ( > 80years) |
SR CS | I | I | U | I | U | RR 0.76 (0.61-0.94) ( > 65 years) RR 0.90 (0.74-1.09) ( > 80 years) |
-16/1000 patients/5 years ( > 65 years) -19/1000 patients/5 years ns ( > 80 years) |
Moderate | ||
| 55 | 4 396 6 290 with treatment /year 6 330 with treatment BQ/year |
BS RCT | I | U | U | U | U | Difference (%): 9% (-12 to 27) ns (treatment vs PBO) 29% (4 to 48) (p=0.03) (D vs PBO) -6% (-39 to 19) ns (BQ-PBO) |
Absolute difference (1000 patients/year): 1.3 (-1.5 a 4.1) ns (treatment vs PBO) |
High | ||
| 56 | 3 845 1 933 with treatment |
RCT | U | U | U | U | U | HR non adjusted 0.77 (0.60 to 1.01) ns |
SAEs 1000 patientss/year (no events): 23.9 (99) (active) vs 30.7(121) (PBO) |
High | ||
| 57 | 55 645-94 228 19 942 with treatment D 7 937 with treatment BQ 23 362 with treatment CA-ANTAG 15 742 with treatment ACE 6 222 with treatment ARBs |
SR CS | I | I | U | I | U | RR 0.85 (0.74-0.98) (D vs PBO) RR 0.98 (0.89-1.07) (D vs others) RR 0.88 (0.62-1.29) (BQ vs PBO) RR 1.39 (1.03-1.88) (BQ vs others) RR 0.50 (0.29-0.89) (CA-ANTAG vs PBO) RR 0.95 (0.89-1.01) (CA-ANTAG vs others) RR 1.04 (0.98-1.11) (ACE vs others) RR 1.11 (0.82-1.49) (ARBs vs PBO) |
UV | High | ||
| What pharmacological options for hypertension are there to improve cardiovascular morbidity and mortality in the elderly? | ||||||||||||
| 54 | 26 795 13 368 with treatment |
SR | VI | U | U | U | U | RR 0.72 (0.68-0.77) ( > 60 years) RR 0.71 (0.65-0.77) (60-79 years) RR 0.75 (0.65-0.87) ( > 80 years) |
93 per 1000 (CI95%: 85 to 101) (treatment) vs 131 per 1000 (control) (60-79 years) ARR = 3.8%. NNTB = 27 115 per 1000 (CI95% 75 to 100) (treatment) vs 86 per 1000 (control) ( > 80 years) ARR = 2.9%. NNTB = 35 |
Moderate-high |
||
| 51 | 96 549 30 299 with treatment ( > 65years) 3 010 with treatment ( > 80years) |
SR CS | I | I | U | I | U | RR 0.72 (0.63-0.82) ( > 65 years) RR 0.75 (0.63-0.88) ( > 80 years) |
-67/1000 patients/5 years ( > 65 years) -66/1000 patients/5 years ( > 80 years) |
Moderate |
||
| 55 | 4 396 6 290 with treatment /year 6 330 with treatment BQ/year |
BS RCT | I | U | U | U | U | Difference (%): 17% (2 a 29) (p=0.03) (Active vs PBO) 35% (17 a 49) (p=0.0005) (D vs PBO) 4% (-19 a 23) (BQ vs PBO) |
Absolute difference (1000 patients/year): 4.2 (0.5 a 7.9) (treatment vs PBO) |
High | ||
| 56 | 3 845 1 933 with treatment |
RCT | U | U | U | U | U | HR non adjusted 0.66 (0.53-0.82) (p < 0.001) | SAEs (1000 patients/year): 33.7 (138) (treatment) vs 50.6 (193) (PBO) |
High | ||
| 57 | 55 645-94 228 19 942 with treatment D 7 937 with treatment BQ 23 362 with treatment CA-ANTAG 15 742 with treatment ACE 6 222 with treatment ARBs |
SR CS | I | I | U | I | U | RR 0.77 (0.69-0.87) (D vs PBO) RR 0.90 (0.82-0.98) (D vs others) RR 0.91 (0.79-1.05) (BQ VS PBO)RR 1.36 (1.11-1.77) (BQ vs others) RR 0.51 (0.31-0.85) (CA-ANTAG vs PBO) RR 1.09 (1.02-1.15) (CA-ANTAG vs others)RR 0.51 (0.39-0.66 ACE vs PBO) RR 0.96 (0.89-1.04) (ACE vs others) RR 0.84 (0.74-0.94) (ARBs vs PBO) RR 0.99 (0.92-1.07) (ARBs vs others) |
UV | High | ||
| What pharmacological options for hypertension are available to improve neurovascular morbidity and mortality in the elderly? | ||||||||||||
| 54 | 26 795 13 368 with treatment |
SR | VI | U | U | U | U | RR 0.66 (0.59-0.74) ( > 60 years) RR 0.66 (0.58-0.76) (60-79 years) RR 0.66 (0.52-0.83) ( > 80 years) |
33 per 1000 (CI95%: 29 to 38) vs 50 per 1000 (control) (60-79 years); ARR 1.7%; NNTB 59 35 per 1000 (CI95%: 27 to 43) vs 52 per 1000 (control) ( > 80 years): ARR 21.7%; NNTB 59 |
Moderate-high | ||
| 51 | 96 549 30 299 with treatment ( > 65years) 3 010 with treatment ( > 80years) |
SR CS | I | I | U | I | U | RR 0.67 (0.58-0.77) ( > 65 years) RR 0.68 (0.54-0.84) ( > 80 years) |
-28/1000 patients/5 years ( > 65 years) -29/1000 patients/5 years ( > 80 years) |
Moderate | ||
| 55 | 4 396 6 290 with treatment /year 6 330 with treatment BQ/year |
BS RCT | I | U | U | U | U | Diffence (%): 25% (3 a 42) (p=0.04) (ACTIVE vs PBO) 31% (3 a 51) (p=0.04) (D vs PBO) 18% (-14 a 40) (BQ vs PBO) |
Absolute difference (1000 patients/year): 2.7 (0.3 a 5.1) (active vs PBO) |
High | ||
| 56 | 3 845 1 933 with treatment |
RCT | U | U | U | U | U | HR non adjusted 0.70 (0.49-1.01) ns | SAEs (1000 patients/year): 12.4 (51) (treatment) vs 17.7 (69) (PBO) |
High | ||
| 57 | 55 645-94 228 19 942 with treatment D 7 937 with treatment BQ 23 362 with treatment CA-ANTAG 15 742 with treatment ACE 6 222 with treatment ARBs |
SR CS | I | I | U | I | U | RR 0.70 (0.60-0.81) (D vs PBO) RR 0.78 (0.69-0.89) (D vs others) RR 0.82 (0.69-0.89) (BQ vs PBO) RR 1.43 (1.16-1.75) (BQ vs others) RR 0.46 (0.26-0.81) (CA-ANTAG vs PBO) RR 0.96 (0.80-1.14) (CA-ANTAG vs others) RR 1.09 (0.93-1.27) (ACE vs others) RR 0.62 (0.38-1.03) (ARBS vs PBO) |
UV | High | ||
| What pharmacological options for hypertension are available to improve acute myocardial infarction in the elderly? | ||||||||||||
| 54 | 26 795 13 368 with treatment |
SR | VI | U | U | U | U | RR 0.78 (0.69-0.88) ( > 60 years) RR 0.79 (0.69-0.90) (60-79 years) RR 0.82 (0.56-1.2) ( > 80 years) |
41 per 1000 (CI95%: 36 to 47) (treatment) vs 52 per 1000 (control) (60-79 years) 17 per 1000 (CI95%: 12 to 25) (treatment) vs 21 per 1000 (control) ( > 80 years) |
Moderate-high | ||
| 51 | 96 549 30 299 with treatment ( > 65years) 3 010 with treatment ( > 80years) |
SR CS | I | I | U | I | U | RR 0.78 (0.66-0.94) ( > 65 years RR) RR 0.96 (0.57-1.63) ns ( > 80 years) |
-7/1000 patients/5 years ( > 65 years)-1/1000 patients/5 years ( > 80 years) | Moderate | ||
| 55 | 4 396 6 290 with treatment /year 6 330 with treatment BQ/year |
BS RCT | I | U | U | U | U | Difference (%): 19% (-2 a 36) (treatment Vs PBO) 44% (21 a 60) (p=0.0009) (D vs PBO) 3% (-30 a 27) ns (BQ vs PBO) |
Absolute difference (1000 P/year): 2.4 (-0.2 a 5.0) (treatment vs PBO) |
High | ||
| 56 | 3 845 1 933 with treatment |
RCT | U | U | U | U | U | HR non adjusted 0.72 (0.30-1.7) | SBP (1000 patients/years. no events): 2.2 (9) (treatment) vs 3.1 (12) (PBO) |
High | ||
| 57 | 55 645-94 228 19 942 with treatment D 7 937 with treatment BQ 23 362 with treatment CA-ANTAG 15 742 with treatment ACE 6 222 with treatment ARBs |
SR CS | I | I | U | I | U | RR 1.03 (0.89-1.20) (D vs others) RR 1.24 (0.91-1.68) (BQ vs others) RR 1.01 (0.93-1.10) (CA-ANTAG vs others) RR 0.93 (0.82-1.04) (ACE vs others) RR 0.93 (0.78-1.10) (ARBs vs others) |
UV | High | ||
| What pharmacological options for hypertension are available to improve the withdrawal due to adverse events in the elderly? | ||||||||||||
| 54 | 26 795 13 368 with treatment |
SR | VI | U | U | U | U | RR 2.91 (2.56-3.30) ( > 60 years) | UV | Moderate- low | ||
| What pharmacological options for hypertension are available to improve the adverse events in the elderly? | ||||||||||||
| 51 | 96 549 30 299 with treatment ( > 65years) 3 010 with treatment ( > 80years) |
SR CS | I | I | U | I | U | RR 1.72 (1.09-2.74) ( > 65 years) RR 4.31 (0.30-62.28) ( > 80 years) |
+100/1000 patients/5 years ( > 65 years) +27/1000 patients/5 years ( > 80 years) |
Moderate-high | ||
| 56 | 3 845 1 933 with treatment |
RCT | U | U | U | U | U | UV | Advers events: 358 (treatment group) vs 448 (PBO); p = 0.001 |
High | ||
| 57 | 55 645-94 228 19 942 with treatment D 7 937 with treatment BQ 23 362 with treatment CA-ANTAG 15742 with treatment ACE 6222 with treatment ARBs |
SR CS | I | I | U | I | U | RR 2.60 (1.38-4.88) (D vs PBO) RR 0.91 (0.27-3.08) (D vs others) RR 2.11 (0.63-7.04) (BQ vs PBO) RR 2.07 (1.74-2.45) (BQ vs others) RR 0.59 (0.45-0.78) (CA-ANTAG vs others) RR 1.17 (0.62-2.16) (ARBs vs PBO) |
UV | High | ||
| What is the effect of exercise on sbp y dbp in the elderly? | ||||||||||||
| 58 | 466 241 with treatment ( > 55years) | SR | VI | I | U | I | U | UV | SBP DWA -3.96 mmHg (N 115 > 55a) SBP DWA −4.71 mmHg (N 73 m > 55a) SBP DWA −6.52 mmHg (N 53 w > 55) DBP DWA -1.30 mmHg (N 115 > 55a) DBP DWA −2.07 mmHg (N 73 m > 55a) DBP DWA −2.40 mmHg (N 53 w > 55) |
Moderate (sbp) low (dbp) |
||