Table 4 Characteristics of the participants in the included studies
Author year | Setting / country / ethnicity | Male sex | Agea | Reported comorbidities | Reported concomitant medications | Functional status/Frailty level | Cognitive status |
|---|---|---|---|---|---|---|---|
Carlsson 2014 [43] | Sweden | 50.14% | Men: mean age 72.3 years, 79% ≥ 65 years. Woman: mean age 77.2 years, 92% ≥ 65 years | Diagnosis of both AF and hypertension (inclusion criteria), coronary heart disease, cerebrovascular diseases, including intracranial bleeding and peripheral embolism, congestive heart failure, DM II | - Diuretic drugs (thiazides, related agents, combined formulations with other drugs, loop diuretics, potassium-saving diuretics) - Beta blocker (ß1-selective, non-selective) - Calcium receptor-blocking agents (vessel-selective, heart-selective) - RAS-Blockers (ACE-inhibitors, ARBs) - Lipid-lowering drugs (statins) - antithrombotic drugs | Not reported | Not reported |
Collier 2011 [44] | UK, Sweden, Denmark, Iceland, Norway, and Finland | Patients ≥65 Amlodipine-based regimen 73.6% Atenolol-based regimen 73.5% | Patients ≥65 Amlodipine-based regimen 71.1 (4.0) Atenolol-based regimen 71.1 (4.0) | Type 2 diabetes mellitus, ECG abnormalities (not LVH), LVH (on ECG or ECHO), Peripheral vascular disease | No previous antihypertensive use, n (%): Amlodipine-based regimen 681 (16.8) Atenolol-based regimen 677 (16.5) Aspirin use, n (%): Amlodipine-based regimen 1066 (26.4) Atenolol-based regimen 1046 (25.5) | Not reported | Not reported |
Coope 1986 [37] | 13 general practices in England and Wales | Intervention group: 29.0% Control group: 32.0% | Intervention group: 68.7 (5.2) years Control group: 68.8 (5.1) years | Intervention group Left ventricular hypertrophy on ECG: n = 8 Cardiac enlargement on chest XRay: n = 22 Control group Left ventricular hypertrophy on ECG: n = 11 Cardiac enlargement on chest XRay: n = 21 | Not stated | Not stated | Not stated |
Subgroup analysis in Coope 1986 [37] | See above | 29.1% (based on own calculations) | 70–79 years | Not stated | See above | See above | See above |
Gelber 2013 [45] | Hawaii, USA (Japanese men) | 100% | Overall mean age: 77 No drug 77.2 (4.2) BB alone 76.2 (3.8) ACE alone 76.7 (4.1) Diuretic alone 77.4 (4.0) CCB alone 76.9 (4.0) Vasodilators alone 76.8 (3.6) BB & 1 other 76.5 (3.6) Other drug combi-nation 77.0 (4.0) | Type 2 diabetes mellitus, CVD (defined as history of myocardial infarction, angina and other coronary heart disease or stroke), APOE | Not reported | Not reported | BB use was not significantly associated with a lower risk of cognitive impairment, suggesting that medication class may be less relevant if the SBP is not adequately controlled. |
Pepine 2003 [34] | 862 primary care sites in 14 countries worldwide Calcium antagonist group (%): White 48.5 Hispanic 35.7 Black 13.4 Asian 0.6 Other/multiracial 1.9 Non-calcium antagonist group (%): White 48.3 Hispanic 35.6 Black 35.6 Asian 0.8 Other/multiracial 1.9 | Calcium antagonist group (%): 48.1 Non-calcium antagonist group (%): 47.7 | Calcium antagonist group: 66,0 (9.7) years Non-calcium antagonist group: 66,1 (9.8) years | Calcium antagonist group (%): Myocardial infarction 32.1 Prior myocardial infarction or abnormal angiogram 52.6 Angina pectoris 66.2 CABG ≥1 month ago 15.5 PCI ≥ 1 month ago 15.2 CABG or PCI 27.3 Stroke 5.3 Left ventricular hypertrophy 21.5 Unstable angina ≥1 month ago 11.4 Arrhythmia 7.1 Heart failure class II-III 5.5 Peripheral vascular disease 11.9 Diabetes 28.1 Hypercholesterolemia 55.9 Renal impairment 1.9 Cancer 3.5 Non-calcium antagonist group (%): Myocardial infarction 31.8 Prior myocardial infarction or abnormal angiogram 53.3 Angina pectoris 67 CABG ≥1 month ago 16.1 PCI ≥ 1 month ago 14.7 CABG or PCI 27.3 Stroke 5.0 Left ventricular hypertrophy 22.3 Unstable angina ≥1 month ago 11.5 Arrhythmia 7.1 | Calcium antagonist group (%): Aspirin© or other antiplatelet inhibitors 57 NSAIDsb 17.6 Antidiabetic medication 22.1 Any lipid-lowering agent 36.8 Nitrates 35.4 Potassium supplement 6.9 Hormone replacement 17.7 Non-calcium antagonist group: Aspirin© or other antiplatelet inhibitors: 56.4 NSAIDs: 17.9 Antidiabetic medication: 22.9 Any lipid-lowering agent: 36.6 Nitrates: 36.6 Potassium supplement 6.9 Hormone replacement 18.5 | Not stated | Not stated |
Heart failure class II-III 5.6 Peripheral vascular disease 12.0 Diabetes 28.6 Hypercholesterolemia 55.6 Renal impairment 1.9 Cancer 3.3 | |||||||
Subgroup analysis in Pepine 2003 [34] | Not stated | Not stated | >70 years | Not stated | Not stated | Not stated | Not stated |
Ruwald 2012 [40] | Denmark, Finland, Iceland, Norway, Sweden, and UK, | 45–66 years: losartan: 51.2% atenolol: 50.6% 67–83 years: losartan: 41.3% atenolol: 42.0% | overall mean age 67 years 46.8% <66 years 53.2% ≥67 years | Any vascular disease: 25% (Coronary heart disease 16%, cerebrovascular disease 8%, peripheral vascular disease 6%), atrial fibrillation: 4% diabetes: 13% isolated systolic hypertension: 14% | Not reported | Not reported | Not reported |
Testa 2014 [46] | Campania/Southern Italy | 41% | Mean age 74.4 (±6.4) 93% ≥ 65 y. | Hypertension (inclusion criteria) Diabetes, chronic renal failure, AF | ACE-inhibitors, diuretics, hypolipidemic drugs | BADL (basic activities of daily living) GDS (geriatric depression scale) | MMSE: Atenolol vs. no Atenolol 24.9 vs. 25.1 (p = 0.841) |
Studies based on the COPE (Combination Therapy of Hypertension to Prevent Cardiovascular Events) trial | |||||||
Author year | Setting / country / ethnicity | Male sex | Age | Reported comorbidities | Reported concomitant medications | Functional status/Frailty level | Cognitive status |
COPE trial Matsuzaki [47] Main trial | Japan | Overall: benidipine plus -ARB: 51% -BB: 50.5% -TD: 50.5% | Benidipine plus -ARB: 63.0 (10.6) -BB: 63.2 (10.8) -TD: 63.1 (10.8) | ARB/BB/TD groups: Overall: previous casdiovascular disease: 13%/11.4%/12.5% Arrhythmia: 2.7%/3.0%/2.4% Diabetes: 13.9%/14.2%/14.4% | ARB/BB/TD groups: Overall: Antiplatelet agents: 8.9%/6.8%/7.3% Lipid-lowering agents: 21.1%/20.4%/21.2% Antidiabetic agents: 6.9%/7.3%/7.2% | Not reported | Not reported |
Ogihara [41] | ≥65 years: -ARB: 43.6% -BB: 43.8% -TD: 42.3% | 46.6% aged ≥65 years (≥65 years: mean age 72.6 years) | ≥65 years: previous cardiovascular disease: 18.3% stroke: 4.4% angina pectoris: 4.8% MI: 1.05/0.7%/1.2% Arrhythmia: 3.6%/3.9%/3.6% Diabetes: 16.5%/16.5%/16.8% | ≥65 years: Antiplatelet agents: 13.7%/10.7%/11.8% Lipid-lowering agents: 23.1%/21.7%/20.4% Antidiabetic agents: 8.6%/9.2%/9.0% | |||
Studies based on the Medical Research Council (MRC) trial | |||||||
Author year | Setting / country / ethnicity | Male sex | Age | Reported comorbidities | Reported concomitant medications | Functional status/Frailty level | Cognitive status |
MRC 1992 [35] Main trial | 226 general practices in England, Scotland, and Wales | Diuretic 42.0% Beta blocker 41,0% Placebo 42,0% | Range 65–74 years. | Not stated | Not stated | Not stated | Not stated |
Bird 1990 [36] | see above | 41.0% | Mean (SD) 70.3 (2.7) years | see above | see above | see above | see above |
Carr 2012 [42] | see above | 42% | Mean age 70.3 years Placebo 70.3 Diuretic 70.3 b-blocker 70.4 | see above | see above | see above | see above |
Lever 1992 [48] | see above | see above | see above | see above | see above | see above | see above |
Lever 1993 [39] | see above | see above | see above | see above | see above | see above | see above |