Does antihypertensive treatment of the elderly prevent cardiovascular events or prolong life? A meta-analysis of hypertension treatment trials

1995 ◽  
Vol 4 (11) ◽  
pp. 943-949 ◽  
Author(s):  
K. A. Pearce
Keyword(s):  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Meta Analysis ◽  
The Elderly ◽  
Hypertension Treatment ◽  
Treatment Trials

Meta-analysis of hypertension treatment trials

The Lancet ◽  
1990 ◽  
Vol 335 (8697) ◽  
pp. 1092-1094 ◽  
Author(s):  
J.M. Cruickshank ◽  
K. Fox ◽  
P. Collins ◽  
MichaelH. Alderman ◽  
NormanM. Kaplan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Hypertension Treatment ◽  
Treatment Trials

scholarly journals Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092634 ◽  
Author(s):  
Chuannan Zhai ◽  
Kai Hou ◽  
Rui Li ◽  
YueCheng Hu ◽  
JingXia Zhang ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
The Elderly ◽  
Statin Treatment ◽  
Comparative Effect ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Central Database

Objective Statins have been shown to be beneficial for the prevention of cardiovascular events. In elderly individuals, the efficacy of statins remains controversial and the comparative effect of statins has not been assessed. Methods MEDLINE, Embase, and the Cochrane Central database were searched for randomized controlled trials that assessed statins in older patients. Results Seventeen trials were analyzed. When used for secondary prevention, statins were associated with reduced risk of cardiovascular events, all-cause mortality, cardiovascular mortality, revascularization, and stroke. When used for primary prevention, statins reduced the risk of myocardial infarction and revascularization, but did not significantly affect other outcomes. A modest difference between pharmaceutical statin products was found, and high-quality evidence indicated that intensive atorvastatin had the greatest benefits for secondary prevention. Conclusions In secondary prevention, evidence strongly suggests that statins are associated with a reduction in the risk of all-cause mortality, cardiovascular events, cardiovascular mortality, and revascularization. However, differences in the effects of various statins do not appear to have significant effects on therapy in secondary prevention for the elderly.

scholarly journals Association of trimethylamine-N-oxide levels with risk of cardiovascular disease and mortality among elderly subjects: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Guixiu Chen ◽  
Lin He ◽  
Xiaotao Dou ◽  
Tao Liu
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
The Elderly ◽  
Elderly Subjects ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
The Relationship ◽  
Related Metabolite

Background: Trimethylamine-N-Oxide (TMAO) is a microbiome-related metabolite that has been linked to cardiovascular and renal function. This study has reviewed and analyzed the relationship between TMAO and all-cause mortality and adverse cardiovascular events in the elderly subjects. Methods: We determined whether this association was modified in the presence of CKD, heart failure and diabetes. Based on the criteria, systematic review and meta-analysis were conducted and performed. Results: A total of 27 prospective cohort studies were retrieved finally to examine the associations. The high TMAO was positively associated with all-cause mortality [HR: 1.38 (95% CI: 1.306 to 1.460)] as well as adverse cardiovascular events. [HR: 1.032 (95% CI: 1.014 to 1.051)]. The association remained upon subgroup analysis for patients with CKD and heart failure but no association for patients with diabetes [HR: 1.15 (95% CI, 0.81–1.64)]. Conclusions: The findings of this review revealed that the TMAO level is associated with all-cause mortality and adverse cardiovascular events.

The effect of antihypertensive treatment on the incidence of stroke and cognitive decline in the elderly: a meta-analysis

2016 ◽  
Vol 12 (2) ◽  
pp. 237-248 ◽  
Author(s):  
Christine Parsons ◽  
Mohammad Hassan Murad ◽  
Stuart Andersen ◽  
Farouk Mookadam ◽  
Helene Labonte
Keyword(s):  
Cognitive Decline ◽  
Antihypertensive Treatment ◽  
Meta Analysis ◽  
The Elderly

scholarly journals Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta‐Analysis of Observational Studies

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Kevin Leow ◽  
Pawel Szulc ◽  
John T. Schousboe ◽  
Douglas P. Kiel ◽  
Armando Teixeira‐Pinto ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
The Elderly ◽  
Aortic Calcification ◽  
Abdominal Aortic Calcification ◽  
Random Effects Models ◽  
Abdominal Aortic ◽  
All Cause Mortality

Background The prognostic importance of abdominal aortic calcification (AAC) viewed on noninvasive imaging modalities remains uncertain. Methods and Results We searched electronic databases (MEDLINE and Embase) until March 2018. Multiple reviewers identified prospective studies reporting AAC and incident cardiovascular events or all‐cause mortality. Two independent reviewers assessed eligibility and risk of bias and extracted data. Summary risk ratios (RRs) were estimated using random‐effects models comparing the higher AAC groups combined (any or more advanced AAC) to the lowest reported AAC group. We identified 52 studies (46 cohorts, 36 092 participants); only studies of patients with chronic kidney disease (57%) and the general older‐elderly (median, 68 years; range, 60–80 years) populations (26%) had sufficient data to meta‐analyze. People with any or more advanced AAC had higher risk of cardiovascular events (RR, 1.83; 95% CI, 1.40–2.39), fatal cardiovascular events (RR, 1.85; 95% CI, 1.44–2.39), and all‐cause mortality (RR, 1.98; 95% CI, 1.55–2.53). Patients with chronic kidney disease with any or more advanced AAC had a higher risk of cardiovascular events (RR, 3.47; 95% CI, 2.21–5.45), fatal cardiovascular events (RR, 3.68; 95% CI, 2.32–5.84), and all‐cause mortality (RR, 2.40; 95% CI, 1.95–2.97). Conclusions Higher‐risk populations, such as the elderly and those with chronic kidney disease with AAC have substantially greater risk of future cardiovascular events and poorer prognosis. Providing information on AAC may help clinicians understand and manage patients' cardiovascular risk better.

scholarly journals Benefits and harms of lower blood pressure treatment targets: systematic review and meta-analysis of randomised placebo-controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e026686 ◽  
Author(s):  
Mattias Brunström ◽  
Bo Carlberg
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Pressure Range ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Major Cardiovascular Events ◽  
All Cause Mortality ◽  
Blood Pressure Range

ObjectivesTo assess the effect of antihypertensive treatment in the 130–140 mm Hg systolic blood pressure range.DesignSystematic review and meta-analysis.Information sourcesPubMed, CDSR and DARE were searched for the systematic reviews, which were manually browsed for clinical trials. PubMed and Cochrane Central Register of Controlled Trials were searched for trials directly in February 2018.Eligibility criteriaRandomised double-blind trials with ≥1000 patient-years of follow-up, comparing any antihypertensive agent against placebo.Data extraction and risk of biasTwo reviewers extracted study-level data, and assessed risk of bias using Cochrane Collaborations risk of bias assessment tool, independently.Main outcomes and measuresPrimary outcomes were all-cause mortality, major cardiovascular events and discontinuation due to adverse events. Secondary outcomes were cardiovascular mortality, myocardial infarction, stroke, heart failure, hypotension-related adverse events and renal impairment.ResultsEighteen trials, including 92 567 participants (34% women, mean age 63 years), fulfilled the inclusion criteria. Primary preventive antihypertensive treatment was associated with a neutral effect on all-cause mortality (relative risk 1.00, 95% CI 0.95 to 1.06) and major cardiovascular events (1.01, 0.96 to 1.06), but an increased risk of discontinuation due to adverse events (1.23, 1.03 to 1.47). None of the secondary efficacy outcomes were significantly reduced, but the risk of hypotension-related adverse events increased with treatment (1.71, 1.32 to 2.22). In coronary artery disease secondary prevention, antihypertensive treatment was associated with reduced risk of all-cause mortality (0.91, 0.83 to 0.99) and major cardiovascular events (0.85, 0.77 to 0.94), but doubled the risk of adverse events leading to discontinuation (2.05, 1.62 to 2.61).ConclusionPrimary preventive blood pressure lowering in the 130–140 mm Hg systolic blood pressure range adds no cardiovascular benefit, but increases the risk of adverse events. In the secondary prevention, benefits should be weighed against harms.PROSPERO registration numberCRD42018088642.

scholarly journals Isolated Diastolic Hypertension and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies With 489,814 Participants

2022 ◽  
Vol 8 ◽  
Author(s):  
Mingyan Huang ◽  
Linzi Long ◽  
Ling Tan ◽  
Aling Shen ◽  
Mi Deng ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
The Elderly ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Increased Risk ◽  
Diastolic Hypertension ◽  
All Cause Mortality

Background: The association between isolated diastolic hypertension (IDH) and cardiovascular events has been inconsistently reported. This meta-analysis of cohort studies was designed to investigate the effect of the 2018 European Society of Cardiology (ESC) definition of IDH on the risk of composite cardiovascular events, cardiovascular mortality, all-cause mortality, and all strokes including ischemic stroke (IS) and hemorrhagic stroke (HS).Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to July 6, 2021. Cohort studies that investigated the association between IDH and cardiovascular events risk, compared to normotension, were included. Pooled hazard ratios (HRs) and 95% CIs were calculated using a random-effects models and heterogeneity was evaluated using Q-test and I2 statistic. The robustness of the associations was identified using sensitivity analysis. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale. Publication bias was assessed using funnel plot, trim-and-fill method, Begg's test, and Egger's test.Results: A total of 15 cohort studies (13 articles) including 489,814 participants were included in this meta-analysis. The follow-up period ranged from 4.3 to 29 years. IDH was significantly associated with an increased risk of composite cardiovascular events (HR 1.28, 95% CI: 1.07–1.52, p = 0.006), cardiovascular mortality (HR 1.45, 95% CI: 1.07–1.95, p = 0.015), all strokes (HR 1.44, 95% CI: 1.04–2.01, p = 0.03), and HS (HR 1.64, 95% CI: 1.18–2.29, p = 0.164), but not associated with all-cause mortality (HR 1.20, 95% CI: 0.97–1.47, p = 0.087) and IS (HR 1.56, 95% CI: 0.87–2.81, p = 0.137). Subgroup analysis further indicated that IDH in the younger patients (mean age ≤ 55 years) and from Asia were significantly associated with an increased risk of composite cardiovascular events, while the elderly patients (mean age ≥ 55 years), Americans, and Europeans were not significantly associated with an increased risk of composite cardiovascular events.Conclusion: This meta-analysis provides evidence that IDH defined using the 2018 ESC criterion is significantly associated with an increased risk of composite cardiovascular events, cardiovascular mortality, all strokes and HS, but not significantly associated with all-cause death and IS. These findings also emphasize the importance for patients with IDH to have their blood pressure within normal, especially in the young adults and Asians.Trial Registration: PROSPERO, Identifier: CRD42021254108.

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