Age can affect treatment outcome in hypertension

This study examined the effectiveness of olmesartan (Benicar) combined with either a calcium channel blocker (CCB), or a diuretic, on blood pressure variability in elderly and very elderly hypertensive patients. The authors concluded that olmesartan combined with a CCB led to decreased blood pressure variability only in very elderly patients.

Treating hypertension in elderly patients can lower the risk of cardiovascular (CV) events (such as heart attack or stroke) or death. Many elderly hypertensive patients require more than one treatment to control high blood pressure. However, it is not yet clear what the best treatment combinations are for the elderly (ages 65-74) and the very elderly (ages 75-84).

Angiotensin II receptor blockers (such as olmesartan) are one type of treatment for hypertension. A previous study compared the effectiveness of olmesartan combined with either a CCB (such as Norvasc) or a diuretic (such as Capozide). The study found no overall difference in the risk of CV events or death between the two treatment groups. However, among the very elderly, olmesartan and a CCB led to fewer CV events. While average blood pressure did not differ between the treatment groups, blood pressure variability may be the reason behind the noted difference in CV events.

The current study examined whether the two treatment combinations affected blood pressure variability in elderly and very elderly patients.

The study included 4876 patients (2778 elderly and 2098 very elderly) who took part in the original study comparing olmesartan and a CCB or a diuretic.  Blood pressure variations were measured during an average follow-up of 3 years. The rates of CV events and death were analyzed and compared to blood pressure measurements.

Very elderly patients in both treatment groups had more variable blood pressure readings than did elderly patients. In both age groups, more variable blood pressure readings were associated with an increased risk of CV events or death.

The combination of olmesartan and a CCB was associated with significantly lower blood pressure variability in very elderly patients, compared to olmesartan and a diuretic. There was no significant difference in the elderly group.

This study concluded that the combination of olmesartan and a CCB was associated with lower blood pressure variability in very elderly patients. Reducing blood pressure variability may contribute to a lower risk of cardiovascular events.

This study included only Japanese patients. It may be that these treatments would affect patients of other ethnicities differently.