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Treatment of hypertension in the elderly with special reference to urapidil
1University of Uppsala Department of Geriatrics, Sweden.
Insights
Antihypertensive treatment significantly reduces stroke and cardiovascular event risks in elderly patients. Studies like SHEP, STOP-Hypertension, and the MRC trial demonstrate the benefits of managing hypertension in older adults.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Three major intervention trials (SHEP, STOP-Hypertension, MRC) published in 1991-1992 evaluated antihypertensive treatment in the elderly.
- These trials focused on the efficacy of treatments primarily involving diuretics or beta-blockers compared to placebo.
Purpose of the Study:
- To assess the value of antihypertensive treatment in reducing cardiovascular events and mortality in older adults.
- To specifically evaluate antihypertensive treatment in elderly patients with isolated systolic hypertension (SHEP trial).
Main Methods:
- Multicenter, prospective, randomized trials comparing active antihypertensive treatment with placebo.
- Two double-blind trials (SHEP, STOP-Hypertension) and one single-blind trial (MRC).
- Patient populations included elderly individuals with hypertension, with SHEP focusing on isolated systolic hypertension.
Main Results:
- All three trials demonstrated that treating hypertension in the elderly reduces the risk of stroke and cardiovascular events.
- The STOP-Hypertension trial showed a 43% reduction in total mortality among the oldest patients with severe hypertension.
- The SHEP trial confirmed benefits for isolated systolic hypertension in the elderly.
Conclusions:
- Antihypertensive treatment is effective in reducing cardiovascular morbidity and mortality in elderly populations.
- Diuretics and beta-blockers are established treatments, with ongoing research (STOP-Hypertension-2) comparing them to newer agents like ACE inhibitors and calcium antagonists.
Abstract:
During 1991 and 1992 three major intervention trials were published that dealt with the value of antihypertensive treatment in the elderly. The three studies were the American Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) and the British Medical Research Council Trial of Treatment of Hypertension in Older Adults. (MRC trial.) The three trials all compared active antihypertensive treatment, mainly consisting of diuretics or beta-adrenoceptor blocking agents or the two in combination, with placebo. Two of the trials were double-blind (SHEP and STOP) whereas the MRC trial was single-blind. All three were multicenter and prospective, and patients were randomized to either of the treatment modalities. One of the trials (SHEP) was specifically designed to evaluate antihypertensive treatment in patients with isolated systolic hypertension. The SHEP, STOP and MRC trials all showed that treatment of hypertension in the elderly reduces the risk of stroke and cardiovascular events. In the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. It could be argued that novel antihypertensive compounds offer equal or better results than the ones obtained with beta blockers and/or diuretics. Angiotensin converting enzyme inhibitors and calcium antagonists are currently being compared with diuretics and beta-blockers in the STOP-Hypertension-2 study which prospectively evaluates morbidity and mortality in hypertensive patients aged 70-84 years.(ABSTRACT TRUNCATED AT 250 WORDS)