Barts and The London, Queen Mary's School of Medicine and Dentistry, UK.
J Hypertens. 2011 Mar;29(3):583-91. doi: 10.1097/HJH.0b013e328342c845.
Older patients experience higher rates of cardiovascular disease than younger patients, but studies have suggested that relative risk reductions due to antihypertensive therapy are lower in older than younger patients. The Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) allowed an evaluation of the efficacy and safety of an amlodipine versus an atenolol-based antihypertensive regimen among older (≥ 65 years) and younger (<65 years) patients.
In ASCOT-BPLA 19 257 patients (8137 aged ≥ 65 years and 11 020 <65 years) were randomly assigned to receive amlodipine or atenolol-based antihypertensive therapy. The primary endpoint (nonfatal myocardial infarction and fatal coronary heart disease) and seven secondary endpoints were consistent with the original trial design.
All cardiovascular endpoints evaluated favoured the amlodipine-based regimen, significantly so in seven of the 16 age-stratified endpoints. Compared with the atenolol-based regimen, the amlodipine-based regimen reduced the relative risk of cardiovascular events by 17% in older and 15% in younger patients (P < 0.01). Overall, older patients experienced more cardiovascular events [n = 1625 (20%)] than younger patients [n = 1339 (12%)]. Discontinuations due to serious adverse events were low in both age groups and less frequent in the amlodipine-based versus atenolol-based regimen: 0.6 versus 1.1% among older patients and 0.4 versus 0.8% among younger patients.
The amlodipine-based regimen reduced the relative risk of cardiovascular events more effectively than the atenolol-based regimen in both older and younger patients. However, because event rates were higher among older patients, the absolute benefits were greater for older compared with younger patients.
老年患者比年轻患者更容易患心血管疾病，但研究表明，降压治疗的相对风险降低在老年患者中低于年轻患者。盎格鲁-斯堪的纳维亚心脏结局试验-降压臂（ASCOT-BPLA）允许评估氨氯地平与阿替洛尔为基础的降压方案在老年（≥65 岁）和年轻（<65 岁）患者中的疗效和安全性。
在 ASCOT-BPLA 中，19257 名患者（8137 名年龄≥65 岁，11020 名<65 岁）被随机分配接受氨氯地平或阿替洛尔为基础的降压治疗。主要终点（非致死性心肌梗死和致死性冠心病）和七个次要终点与原试验设计一致。
所有心血管终点均有利于氨氯地平为基础的方案，在 16 个年龄分层终点中有 7 个显著有利于氨氯地平为基础的方案。与阿替洛尔为基础的方案相比，氨氯地平为基础的方案降低了老年患者和年轻患者心血管事件的相对风险 17%和 15%（P<0.01）。总的来说，老年患者发生心血管事件的比例高于年轻患者[分别为 1625 例（20%）和 1339 例（12%）]。在两个年龄组中，因严重不良事件而停药的情况均较低，且氨氯地平为基础的方案比阿替洛尔为基础的方案更为少见：老年患者为 0.6%比 1.1%，年轻患者为 0.4%比 0.8%。
在老年和年轻患者中，氨氯地平为基础的方案比阿替洛尔为基础的方案更有效地降低了心血管事件的相对风险。然而，由于老年患者的事件发生率较高，与年轻患者相比，老年患者的绝对获益更大。
