Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and the intervention is more effective/beneficial than the comparison for key outcomes.
Population: Adults aged ≥60 years (mean age 64-84 years where reported) with moderate-to-severe systolic and/or diastolic hypertension (average 182/95 mmHg)
Intervention: Antihypertensive drug therapy
Comparison: Placebo or no treatment/observation
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
All‐cause mortality (mean follow‐up 3.8 years) | Favours intervention | High |
Cardiovascular mortality and morbidity (mean follow‐up 3.7 years) | Favours intervention | Moderate |
Cerebrovascular mortality and morbidity (mean follow‐up 3.7 years) | Favours intervention | Moderate |
Coronary heart disease mortality and morbidity (mean follow‐up 2.9 years) | Favours intervention | Moderate |
Withdrawal due to adverse effects (mean follow‐up 4.6 years) | Occurs more commonly with antihypertensive drug therapy compared with placebo or no treatment/observation (favours comparison) | Low |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) notes that the reduction in mortality in the antihypertensive group occurred mostly in the 60- to 79-year-old patient group. It also notes that while a statistically significant reduction in cardiovascular mortality and morbidity occurred in both those aged 60 to 79 years and in those aged 80 years and older, the size of the absolute risk reduction was greater in the former (3.8% vs 2.9%). The Cochrane review also highlights that the reduction in mortality occurred in studies with the least blood pressure reduction and lowest intensity of therapy, suggesting that less aggressive treatment be used for those over the age of 80. Please see the Cochrane review for more details.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does pharmacotherapy affect outcomes in people aged 60 years or older with hypertension?
- How does first‐line combination therapy compare with first‐line monotherapy in people with primary hypertension?
- How do renin‐angiotensin system inhibitors compare with other first‐line antihypertensive drugs in people with hypertension?
- What are the effects of renal denervation for people with resistant hypertension?
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