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Use of diuretics in treatment of hypertension in the elderly
Insights
Chlorthalidone effectively lowered systolic blood pressure in older adults with isolated systolic hypertension. This thiazide diuretic demonstrated significant efficacy and good compliance over one year.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Isolated systolic hypertension (ISH) is a prevalent condition in older adults.
- Effective management of ISH is crucial for reducing cardiovascular risk.
Purpose of the Study:
- To evaluate the efficacy and safety of chlorthalidone as a first-line treatment for ISH in individuals aged 60 years and older.
- To assess blood pressure response across different demographic subgroups.
Main Methods:
- A randomized, placebo-controlled trial involving men and women aged 60+ with ISH.
- Participants received either chlorthalidone (25-50 mg daily) or a placebo for one year.
- Blood pressure, serum electrolytes, and uric acid levels were monitored.
Main Results:
- Chlorthalidone significantly reduced systolic blood pressure by 17 mm Hg and diastolic blood pressure by 6 mm Hg compared to placebo (p < 0.001).
- Blood pressure response was consistent across age, sex, and race subgroups.
- Adverse effects included minor, asymptomatic changes in serum potassium, uric acid, and creatinine levels.
- Over 80% of participants maintained good compliance throughout the study.
Conclusions:
- Chlorthalidone is an effective and well-tolerated monotherapy for isolated systolic hypertension in older adults.
- The medication offers a favorable benefit-risk profile for this population.
- Further research may explore long-term outcomes and optimal dosing strategies.
Abstract:
Men and women with isolated systolic hypertension who were at least 60 years of age were treated for 1 year with chlorthalidone (25-50 mg daily) or matching placebo as the step I drug. Most patients reached goal blood pressure without requiring a step II drug. The blood pressure response was similar in all age, sex and race subgroups, with an overall difference between the randomised groups of 17 mm Hg for systolic blood pressure (p less than 0.001) and 6mm Hg for diastolic blood pressure (p less than 0.001). The only common adverse effects were asymptomatic changes in the serum concentrations of potassium (0.5 mmol/L lower in the chlorthalidone group, p less than 0.001), uric acid (0.9 mg/dl higher, p less than 0.001), and creatinine (0.08 mg/dl higher, p = 0.02). Compliance was good, and more than 80% of participants were still taking the study medications at the end of the year.