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Treatment of hypertension in the elderly
1Department of Medicine, University of Göteborg, Ostra Hospital, Sweden.
Insights
Three major trials show that treating hypertension in the elderly with diuretics and beta-blockers significantly reduces stroke risk. Further research is exploring if calcium antagonists offer even greater benefits for cardiovascular health in older adults.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Three landmark prospective, placebo-controlled trials (SHEP, STOP Hypertension, MRC Study) investigated antihypertensive treatments in elderly populations between 1991 and 1992.
- These studies focused on the efficacy of active treatment versus placebo in managing hypertension among older adults.
Purpose of the Study:
- To evaluate the benefits of antihypertensive interventions in elderly patients.
- To assess the impact of treatment on cardiovascular morbidity and mortality, particularly stroke prevention.
Main Methods:
- Comparison of active antihypertensive drug regimens (diuretics and/or beta-blockers) against placebo.
- Inclusion of elderly patients diagnosed with hypertension in prospective, randomized trial designs.
Main Results:
- All three trials demonstrated significant benefits from active antihypertensive treatment, most notably a reduction in stroke incidence.
- The SHEP trial also reported positive effects on coronary heart disease morbidity, while the STOP Hypertension study showed a significant decrease in total mortality.
Conclusions:
- Established antihypertensive treatments, primarily diuretics and beta-blockers, are effective in reducing cardiovascular events in the elderly.
- Emerging evidence suggests that novel drug classes, such as calcium antagonists, may offer superior cardiovascular protection and improved tolerability in this demographic, with ongoing trials (e.g., STOP-Hypertension-2) to confirm these findings.
Abstract:
In the span of little more than half a year, three major, prospective, placebo-controlled intervention trials against hypertension in the elderly were published, i.e., the Systolic Hypertension in the Elderly Program (SHEP) from the United States in 1991, the Swedish Trial in Old Patients with Hypertension (STOP Hypertension), also in 1991, and the Medical Research Council (MRC) Study in older adults from the United Kingdom in 1992. These trials compared active antihypertensive treatment in elderly patients to placebo, and all found significant benefits from active treatment, particularly against stroke. In the SHEP trial, coronary heart morbidity was also positively affected, and in the STOP Hypertension study total mortality was reduced significantly. In all the three studies, active treatment consisted of diuretics and/or beta-blockers, usually given in combination. It is conceivable that novel classes of compounds, e.g., the calcium antagonists, might have shown even better results in the prevention of cardiovascular morbidity and mortality, in view of their neutral metabolic profile and possible antiatherosclerotic effect. Studies are currently in progress to test this possibility, e.g., the STOP-Hypertension-2 study. While the results of such ongoing trials are awaited, it is worth noting that treatment with calcium antagonists in the elderly, e.g., with lacidipine, in several studies has been shown to be remarkably effective and well tolerated. This raises the possibility that results of antihypertensive treatment in the elderly could become even better than those already obtained in the SHEP, STOP-Hypertension, and MRC trials.