Should we prefer different drugs to treat hypertension in older and younger adults? Practical implications of clinical trials: American perspective

Whether older and younger persons derive similar benefit from antihypertensive treatment and whether treatment choices should be tailored to the age of the patient are unresolved issues about which there is a paucity of evidence. The Blood Pressure Lowering Treatment Trialists' Collaboration has attempted to address this deficiency in a meta-analysis that included 31 trials with 190,606 participants. They compared the proportionate risk reductions achieved with different classes of antihypertensive drugs in younger (<65 years) and older (>65 years) adults. They reported that there was no clear evidence to support recommendations for particular antihypertensive drug classes in older or younger adults. In this paper we discussed the Trialists’ paper and its limitations and strenghts, current guidelines recommendations, and the major conclusions that are important for clinicians.