Impact of age and gender on blood pressure and low-density lipoprotein cholesterol reduction: Results of a pooled analysis
Feldman RD., Flack J., Howes L., Jenssen T., Reeves R., Shi H., Westergaard M., Hobbs FDR.
Objectives:To compare the simultaneous reduction of blood pressure (BP) to below 150mmHg and low-density lipoprotein cholesterol (LDL-C) after treatment with single-pill amlodipine/atorvastatin (SPAA) among younger ( < 65 years), older (65 years) and elderly (75 years) men and women with hypertension and dyslipidemia. Methods:Data from five, 1420-week, open-label, multi-national studies (GEMINI US, GEMINI-Australia, Asia, Latin-America, Africa/Middle-East [AALA], JEWEL 1, JEWEL 2, and the Clinical Utility of Caduet in Simultaneously Achieving Blood Pressure and Lipid End Points [CAPABLE] ) were pooled. In these studies, SPAA (5/10 to 10/80mg/mg) was electively titrated to achieve study-specific targets. Reductions in BP and LDL-C, and changes in renal and liver function tests, fasting glucose and adverse event (AE) rates were compared across the three age groups. Results:A total of 3613 patients (65) were < 65 years, 1946 (35) were 65 years and 441 (8) were 75 years. Baseline mean systolic BP tended to increase with age and diastolic BP and LDL-C decreased, p < 0.001. Final mean SPAA dose was similar (7.2/23.9, 7.1/24.3, 7.1/24.0mg/mg). Final mean BP in the younger/older/elderly groups was 128.1/79.9, 131.3/75.0, 132.8/73.4mmHg (adjusted BP reductions-20.2/-10.4,-18.6/ -12.7,-17.7/-13.2mmHg, p < 0.001). Final mean LDL-C was 91, 87, 87mg/dl (2.4, 2.3, 2.3mmol/l) p < 0.001; adjusted LDL-C reductions-27.1,-26.8,-26.4, p < 0.001. Estimated glomerular filtration rate increased in the younger group but decreased in the older and elderly groups (p < 0.005). Small increases in liver function tests and fasting glucose were observed. Discontinuations due to AEs tended to increase with age but were low in all groups (6.2, 7.9, 8.8, p < 0.045). Study limitations include post hoc analysis and short duration of follow-up. Conclusions:Simultaneous reduction of BP to below 150mmHg and LDL-C using SPAA is both effective and well-tolerated among younger and older men and women, including those aged75 years. Clinicians may be reassured by the low proportion of AEs that led to discontinuation in all groups suggesting that older patients were not disadvantaged by this treatment. © 2012 Informa UK Ltd All rights reserved.