Some authorities recommend selective use of antihypertensive drugs based on patient age. For example, some recommend angiotensin-converting–enzyme inhibitors and β-blockers as initial blood-pressure-lowering drugs for younger patients and diuretics for older patients because younger patients tend to have higher renin levels than do older patients. However, little evidence supports this recommendation. In this meta-analysis of 31 prospective randomized trials that involved more than 190,000 patients, investigators compared relative risk reductions for cardiovascular events (stroke, coronary heart disease, and heart failure) associated with various antihypertensive drug regimens in younger (age, <65) versus older (age,
65) adults.In trials that compared antihypertensive regimens with placebo, or more-intensive antihypertensive regimens with less-intensive regimens, relative risk reductions did not differ significantly between the two age groups. Similar results were found for trials in which antihypertensive regimens based on different drug classes were compared. Finally, risk reduction achieved per unit of reduction in blood pressure reduction did not differ between the two age groups.
Comment: Both younger and older adults with hypertension benefit from blood pressure control. However, this study provides no evidence for selective use of specific antihypertensive drug regimens according to age.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine June 12, 2008