Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials

BMJ. 2008 May 17;336(7653):1121-3. doi: 10.1136/bmj.39548.738368.BE. Epub 2008 May 14.


Objective: To quantify the relative risk reductions achieved with different regimens to lower blood pressure in younger and older adults.

Design: Meta-analyses and meta-regression analyses used to compare the effects on the primary outcome between two age groups (<65 v > or =65 years). Evidence for an interaction between age and the effects of treatment sought by fitting age as a continuous variable and estimating overall effects across trials.

Primary outcome: total major cardiovascular events.

Results: 31 trials, with 190 606 participants, were included. The meta-analyses showed no clear difference between age groups in the effects of lowering blood pressure or any difference between the effects of the drug classes on major cardiovascular events (all P> or =0.24). Neither was there any significant interaction between age and treatment when age was fitted as a continuous variable (all P>0.09). The meta-regressions also showed no difference in effects between the two age groups for the outcome of major cardiovascular events (<65 v > or =65; P=0.38).

Conclusions: Reduction of blood pressure produces benefits in younger (<65 years) and older (> or =65 years) adults, with no strong evidence that protection against major vascular events afforded by different drug classes varies substantially with age.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Cerebrovascular Disorders / etiology
  • Cerebrovascular Disorders / mortality*
  • Harm Reduction
  • Heart Diseases / etiology
  • Heart Diseases / mortality*
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / mortality
  • Middle Aged
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Risk Factors


  • Antihypertensive Agents