Of concern is that in this Cochrane review,389 when patients aged Z80 years were specifically considered, there was no overall reduction in the risk of total mortality with treatment of BP vs. no treatment (RR 1.01; 95% CI 0.90 1.13), although the reduction in risk of cardiovascular mortality (RR 0.75; 95% CI 0.65 0.87) was similar to that seen in patients 60 to 80 years of age. This is in accordance with a 1999 subgroup meta-analysis of seven RCTs represent- ing 1670 patients aged Z80 years (who had participated in trials of anti-hypertensive agents) indicating that treatment vs. no treatment was associated with a decrease in the rates of strokes, major cardiovascular events and heart failure but, similar to the Cochrane findings, there was no benefit of treatment in terms of cardiovascular death or overall Similarly, a 2010 meta-analysis of 8 RCTs involving treatment of BP in subjects 80 years and older found that treatment of high BP reduced the risk of stroke, cardiovascular events and heart failure, but had no effect on Meta-regression analysis suggested that mortality reduction was achieved in the trials with the least BP reductions and lowest intensity of therapy. These findings suggest that there might be deleterious effects resulting from BP treatment in the very elderly undermining the advantages brought about by the reduced risk of cardiovascular events. An observational cohort study involving 4071 hyper- tensive individuals aged 80 years or older (mainly men, since they were recruited from the Veterans Affairs Administra- tion) supports this notion.43 All subjects were classified as hypertensive according to the International Classification of Diseases (ICD-9) code, 9.9% as having chronic renal failure, and 84.5% were taking anti-hypertensive medica- tions. A J-shaped relationship between BP and survival was seen. 