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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Hypertension Meta-Analysis

The British Medical Journal has published the results of a meta-analysis of hypertension trials that aimed to quantify the relative risk reductions achieved with different regimens in younger and older adults.

The study reviewed 31 trials, including 190,606 participants. The primary outcome was major cardiovascular events compared in two age groups, those under 65 and those over 65 years old. The data were analysed in several different ways to compare active treatments with placebo or alternative active comparators.

The study found no difference in the primary outcome when comparing different drug regimens (P≥0.24 in all cases) and there was no clear difference in blood pressure lowering effects in the different age groups. An accompanying editorial discusses some of the limitations in the study including the arbitrary age cut-off and also attempts to integrate the results of this analysis into the existing evidence base and current guidelines.

The authors conclude that, "Reduction of blood pressure produces benefits in younger and older adults, with no strong evidence that protection against major vascular events afforded by different drug classes varies substantially with age".

Action: Clinicians should continue to implement the existing national guidelines for hypertension irrespective of age. Effective control of hypertension is key in the management of overall cardiovascular risk.

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