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First-line therapy for hypertension: different patients, different needs
1University of California, San Francisco.
Insights
Antihypertensive therapy effectively prevents strokes and heart failure. Recent trials show it can also reduce heart attacks and cardiovascular mortality in older adults with isolated systolic hypertension.
Area of Science:
- Cardiovascular Medicine
- Geriatrics
- Pharmacology
Background:
- Antihypertensive therapy is proven to prevent strokes and heart failure.
- Most trials have not demonstrated a reduction in coronary events or mortality.
- Isolated systolic hypertension (ISH) is common in the elderly.
Purpose of the Study:
- To evaluate the impact of antihypertensive therapy on coronary events and mortality in elderly patients with ISH.
- To review the findings of recent trials in this population.
Main Methods:
- Analysis of data from the Systolic Hypertension in the Elderly Program (SHEP).
- Review of findings from the Swedish STOP-Hypertension Trial and the British MRC Trial in Older Patients.
- Focus on trials using diuretics and/or beta blockers.
Main Results:
- The SHEP trial demonstrated a reduction in myocardial infarctions (MIs) and other coronary events in elderly patients with ISH.
- Cardiovascular mortality was also reduced in the SHEP trial.
- A trend toward reduced coronary events was observed in the Swedish and British trials.
Conclusions:
- Antihypertensive therapy, particularly with diuretics and beta blockers, can reduce coronary events and cardiovascular mortality in older adults with ISH.
- Further long-term data are needed for calcium channel blockers and ACE inhibitors.
- Treatment choices should consider individual patient responses and comorbidities.
Abstract:
There is ample evidence that antihypertensive therapy prevents strokes, congestive heart failure, and other blood pressure-related complications, but most trials have failed to show a reduction in coronary events and mortality. Recently, the Systolic Hypertension in the Elderly Program (SHEP) showed a reduction in MIs and other coronary events in older patients with moderate to severe ISH. Cardiovascular mortality was also reduced and there was a trend toward a reduction in coronary events in the Swedish STOP-Hypertension Trial and the British MRC Trial in Older Patients. These studies have in common the use of diuretics and/or beta blockers. Although there are no similar long-term data with calcium channel blockers and ACE inhibitors, they will be the drugs of choice for many patients, based on individual responses and accompanying medical conditions.