Dataset Information

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression.

ABSTRACT:

Background

Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events.

Objectives

This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults.

Methods

We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different BP treatments/targets and/or active BP against placebo treatment, with a minimum 12 months follow-up, were included. Risk ratios (RR) and 95% CIs were calculated using a random effects model. The primary outcome was RR of major cardiovascular events (MCEs); secondary outcomes included myocardial infarction (MI), stroke, heart failure (HF), cardiovascular (CV) mortality, and all-cause mortality.

Results

We included 16 studies totaling 65,890 hypertensive participants (average age 69.4 years) with a follow-up period from 1.8 to 4.9 years. Intensive BP treatment significantly reduced the relative risk of MCEs by 26% (RR:0.74, 95%CI 0.64-0.86, p = 0.000; I ² = 79.71%). RR of MI significantly reduced by 13% (RR:0.87, 95%CI 0.76-1.00, p = 0.052; I ² = 0.00%), stroke by 28% (RR:0.72, 95%CI 0.64-0.82, p = 0.000; I ² = 32.45%), HF by 47% (RR:0.53, 95% CI 0.43-0.66, p = 0.000; I ² = 1.23%), and CV mortality by 24% (RR:0.76, 95%CI 0.66-0.89, p = 0.000; I ² = 39.74%). All-cause mortality reduced by 17% (RR:0.83, 95%CI 0.73-0.93, p = 0.001; I ² = 53.09%). Of the participants - 61% reached BP targets and 5% withdrew; with 1 hypotension-related event per 780 people treated.

Conclusions

Lower BP treatment targets are optimal for CV protection, effective, well-tolerated and safe, and support the latest hypertension guidelines.

SUBMITTER: Baffour-Awuah B

PROVIDER: S-EPMC7803055 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Publications

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression.

Baffour-Awuah Biggie B Dieberg Gudrun G Pearson Melissa J MJ Smart Neil A NA

International Journal of Cardiology. Hypertension 20200707

<h4>Background</h4>Managing blood pressure reduces CVD risk, but optimal treatment thresholds remain unclear as it is a balancing act to avoid hypotension-related adverse events.<h4>Objectives</h4>This systematic review, meta-analysis and meta-regression evaluated the benefits of intensive BP treatment in hypertensive older adults.<h4>Methods</h4>We systematically searched PubMed, MEDLINE, EMBASE, and the Cochrane Library of Controlled Trials until January 31, 2020. Studies comparing different B ...[more]

PMID: 33447766

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Project description:BackgroundHypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa.MethodsWe searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ?50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies.FindingsWe screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results.ConclusionThe persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.

Project description:Background: The modified Dietary Approaches to Stop Hypertension (DASH) diet was a potentially effective treatment for pre-hypertensive and hypertensive patients. The evidence for the effect of the modified DASH diet on blood pressure reduction was inconsistent. The study was designed to assess the effects of the modified DASH diet on blood pressure (BP) in hypertensive and pre-hypertensive adults. Methods: We searched Medline, Embase, CENTRAL, CNKI, VIP, Wanfang Data, SINOMED, Google Scholar, the World Health Organization's International Clinical Trials Registry Platform, and Clinicaltrials.gov from inception to July 1st, 2021. Randomized controlled trials (RCTs) assessing the effects of the modified DASH diet on systolic and diastolic BP, cardiovascular risk factors (body weight, body mass index, waist circumference, fasting glucose, blood lipids), cardiovascular events, and all-cause mortality were included. Statistical analysis was performed using Stata software. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE. Results: A total of 10 RCTs were included. Compared with control diet, the modified DASH diet could reduce mean systolic (-3.26 mmHg; 95% confidence interval -5.58, -0.94 mmHg; P = 0.006) and diastolic (-2.07 mmHg; 95% confidence interval -3.68, -0.46 mmHg; P = 0.01) BP. Compared with the controlling diet, the modified DASH diet could reduce systolic BP to a greater extent in trials with a mean baseline BP ≥ 140/90 mmHg compared with <140/90 mmHg. Diastolic BP reduction was greater when the mean body mass index was ≥30 kg/m2 than <30 kg/m2. Diastolic BP reduction was more marked in trials with a follow-up time of >8 weeks compared with ≤8 weeks. The modified DASH diet could affect mean waist circumference (difference: 1.57 cm; 95% confidence interval -2.98, -0.15) and triglyceride concentration (difference: 1.04 mol/L; 95% confidence interval -1.47, -0.60). Conclusions: The modified DASH diet can reduce BP, waist circumference, and triglyceride concentration in hypertension patients. A higher baseline BP is associated with more marked systolic and diastolic BP reduction. Systematic Review Registration: PROSPERO registration number: CRD42020190860.

Dataset Information

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression.

Background

Objectives

Methods

Results

Conclusions

Publications

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression.

Similar Datasets

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