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Treatment of elderly hypertensives: results and implications of recent trials
J P Cox1, E T O'Brien, K O'Malley
1Department of Geriatric Medicine, St. James's Hospital, Dublin, Ireland.
Insights
Antihypertensive treatment benefits elderly patients by reducing nonfatal strokes. Further research into alternative medications is recommended due to side effects and varying efficacy in older adults.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Antihypertensive treatment efficacy varies across age groups.
- Elderly populations present unique challenges in hypertension management.
- Previous trials show differing outcomes for cardiac events and stroke reduction.
Purpose of the Study:
- To review antihypertensive treatment trials focusing on elderly individuals.
- To analyze the implications of treatment benefits and side effects in older adults.
- To identify potential alternative antihypertensive drugs for the elderly.
Main Methods:
- Review of recent clinical trials, including the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial.
- Comparison of outcomes between elderly (EWPHE) and non-elderly (Australian National Blood Pressure Study, Medical Research Council) trial participants.
- Analysis of treatment effects on cardiac deaths, strokes (fatal and nonfatal), and drug-induced side effects.
Main Results:
- Fewer cardiac deaths were observed in the EWPHE trial compared to trials with non-elderly participants.
- Treatment benefits in non-elderly groups were primarily attributed to stroke reduction.
- A significant reduction in nonfatal strokes was noted in the EWPHE trial, but not in fatal strokes.
- Diuretic-induced side effects were common in the EWPHE trial.
Conclusions:
- The combination of hypertension and myocardial infarction appears particularly lethal in the elderly.
- Reducing nonfatal stroke incidence in the elderly is a significant treatment benefit.
- Alternative antihypertensive drugs should be investigated for the elderly due to propranolol's age-related efficacy and diuretic side effects.
Abstract:
The results of recent trials on the value of antihypertensive treatment are reviewed with special reference to their implications for the elderly. In the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial, there were fewer cardiac deaths on active treatment than in the Australian National Blood Pressure Study (ANBPS) and the Medical Research Council (MRC) trial in which the patients were not elderly and the benefits with treatment were attributable to fewer strokes. An explanation for this difference may be that the combination of hypertension and myocardial infarction is especially lethal in the elderly. In the EWPHE trial there was a significant reduction in nonfatal strokes but not in fatal strokes. The benefits from reducing the incidence of nonfatal stroke in this population merit consideration. As propranolol was less effective than bendrofluazide in lowering blood pressure with increasing age in the MRC trial, and as the incidence of diuretic-induced side effects in the EWPHE trial was high it seems appropriate to study alternate antihypertensive drugs in the elderly.