Abstract 14816: Competing Risk of Myocardial Infarction vs Stroke in the Elderly Treated for Hypertension: A Meta-analysis of Randomized Trials

Background: Several trials have reported beneficial effects of systolic blood pressure (SBP) control in the elderly in reducing cerebrovascular events. However, concerns regarding a possible J-curve relationship between diastolic blood pressure (DBP) lowering and incident myocardial infarction (MI) warrant against aggressive DBP lowering. Therefore, it remains unclear if the risks of MI outweigh those of stroke at the BP achieved and whether more aggressive BP control is safe. Methods: We searched PubMed and Scopus databases from inception until May 2014 for randomized controlled trials (RCTs) in which elderly patients (>65 years) were randomized to different antihypertensive treatments or to placebo and achieved different levels of BP control. A comparative estimate was made for the combined rates of MI and stroke in the framework of a meta-analysis and expressed as risk ratios (RRs) and 95% confidence intervals. Results: We included 49,296 patients from 13 RCTs. In the overall population, the rates of stroke (4.6%) were significantly higher than the rates of MI (2.9%) (RR: 2.01, 95% CI, 1.64 to 2.45; p< 0.00001). In the less aggressive management group, the range of BP achieved was 142-178/72-97 mmHg and the risk of stroke exceeded the risk of MI (RR: 2.71, 95% CI, 1.77 to 4.14; p<0.0001). Similar results were found in the group treated more aggressively with achieved BP range of 136-159/68-85 mmHg (RR: 1.70, 95% CI, 1.36 to 2.12; p<0.00001). Conclusion: Regardless of the BP level achieved, the risk of stroke far outweighed the risk of MI in the elderly treated for hypertension suggesting need for more specific and/or aggressive antihypertensive therapy. ![][1] [1]: /embed/graphic-1.gif