Until recently, randomized controlled trial data in this
setting has been sparse as a result of the exclusion of older
people from trials or because older people were recruited
to studies in number so low that no meaningful analysis
of the subgroup could be carried out.
Gueyffier et al (1999; Figure 1) published a metaanalysis
on antihypertensive drugs in very old people;
data on 1670 patients over 80 years of age from all
randomized trails of antihypertensive treatment were
included. The authors reported that 57 strokes (6.5%)
and 34 deaths (3.9%) occurred in 874 patients being
treated, while 77 strokes (9.6%) and 28 deaths (3.5%)
occurred in the 796 controls. The authors concluded thatanti-hypertensive treatment conferred a 34% reduction
in strokes, but was associated with a non-significant
excess in all-cause mortality (6%). The study findings
were non-conclusive and highlighted the need for a large
scale specific trial in this patient group. At this time, the
position was that (Gueyffier et al, 1999):
■■ Elderly patients with high BP were at a high risk
of events
■■ Epidemiological data showed a possible inverse link
between BP and mortality
■■ Few randomized controlled trials had been undertaken
in very elderly patients specifically, and they were
under-represented in other trials on BP
■■The meta-analysis was inconclusive regarding the
safety and efficacy regarding the BP treatment.
The European Society of Hypertension (ESH) and the
European Society of Cardiology (ESC) stated, in 2007,
that ‘in subjects of 80 years or over, evidence for benefits
of anti-hypertensive treatment is as yet inconclusive’
(Mancia et al,