Abstract 4152: Did Older or Younger Patients Benefit More from Amlodipine based vs Atenolol based Therapy in ASCOT-BPLA?
Many patients start antihypertensive therapy after the calculation of absolute 10 year CV risk. Whilst we focus treatment on patients at higher absolute risk, who are often older, the proportion of events prevented by such therapy may be less. Blood pressure reduction reduced relative risk by less in the elderly in both the Prospective Studies Collaboration and the Asian Pacific Cohorts Collaboration, than in the younger cohorts. The steeper relationship between BP and events in the younger age group suggest a greater realtive benefit, although the absolute benefit would still be greater in the elderly. The extent of risk reduction achieved by BP lowering therapy in the elderly is thus very important. From the ASCOT-BPLA study (Anglo-Scandinavian Cardiac Outcomes Trial- Blood Pressure Lowering Arm) 8,137 patients >= 65 years were compared with 11,020 patients <65. The mean BP difference during the trial was 1.7/1.7 mmHg in the younger and 4.2/2.2 mmHg in the older group, lower on amlodipine based therapy. Relative risk was reduced similarly in both older and younger patients (no heterogeneity between the <65 and >=65 in the HR’s). The absolute CV event rate reduction/1000 pt years was higher in the elderly, as expected. The treatments were only slightly less well tolerated in the elderly: discontinuations due to serious or non-serious adverse events were in the amlodipine arm 8.5% vs 11.3% (younger vs elderly) and in the atenolol arm 9.4% vs 13.6% (younger vs elderly).
Conclusion: Relative reduction of CV risk was similar in older and younger patients, and the absolute CV benefit was about twice as great in the elderly.