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Hypertensive Old People in Edinburgh (HOPE) Study: electrocardiographic changes after captopril or bendrofluazide
1Geriatric Unit, City Hospital, Edinburgh.
Insights
Captopril effectively lowers blood pressure in elderly individuals with hypertension and mild cognitive impairment. This antihypertensive medication showed positive effects on electrocardiogram (ECG) measures, suggesting cardiac benefits.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Hypertension is a significant risk factor for stroke and heart disease in the elderly population.
- Mild cognitive impairment is common in older adults and may be exacerbated by hypertension.
Purpose of the Study:
- To compare the efficacy and cardiac safety of captopril versus bendrofluazide in elderly hypertensive patients with mild cognitive impairment.
- To assess the impact of these antihypertensive treatments on electrocardiogram (ECG) parameters.
Main Methods:
- A double-blind, randomized trial involving 80 hypertensive subjects over 70 years old with mild cognitive impairment.
- Participants received either captopril (12.5 mg twice daily) or bendrofluazide (2.5 mg daily) for 24 weeks.
- Electrocardiograms (ECGs) were recorded at baseline, 12 weeks, and 24 weeks to evaluate cardiac changes.
Main Results:
- Both captopril and bendrofluazide significantly reduced mean blood pressure equally.
- Captopril demonstrated a significant reduction in QRS duration at 12 and 24 weeks (p=0.004, p=0.002).
- Captopril also showed a significant improvement in overall ECG classification at 12 weeks (p<0.05), though not sustained at 24 weeks.
Conclusions:
- Captopril is a viable alternative to bendrofluazide for managing hypertension in elderly individuals.
- Captopril appears to offer advantages regarding ECG-detected cardiac complications compared to bendrofluazide in this population.
Abstract:
Hypertension is a major risk factor for stroke and heart disease in elderly people. Eighty hypertensive subjects with mild cognitive impairment, aged over 70 years were drawn from a community screening programme and randomized to either captopril 12.5 mg twice daily or bendrofluazide 2.5 mg daily in a double-blind trial. Subjects were excluded if they had previously received antihypertensive treatment or had significant cardiac disease. Electrocardiograms (ECG) were recorded and scored at baseline and after 12 and 24 weeks of treatment. Mean blood pressure fell significantly and equally in both treatment groups. Most ECG variables remained unchanged throughout the trial but a significant reduction in QRS duration from 0.08 to 0.07 seconds was observed with captopril at 12 weeks (p = 0.004) and 24 weeks (p = 0.002). Subjects on captopril also exhibited a significant improvement in overall ECG classification at 12 weeks (p < 0.05), although this was not sustained at 24 weeks (p = 0.076). Captopril is a suitable alternative to bendrofluazide as an antihypertensive drug for elderly people with regard to ECG detected cardiac complications.