Treatment of Hypertension in the Elderly and Its Effect on Stroke

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. The three trials all compared active antihypertensive treatment, mainly consisting of diuretics or β-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, 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 two of the trials total mortality was also positively affected, and in the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. Based on these trials, it is apparent that antihypertensive treatment with low dose thiazides or β-blockers or the two in combination produced highly beneficial results in elderly patients, i.e. a reduction in stroke and other cardiovascular events as well as in total mortality. Special analyses indicate that the cost/benefit aspects of such treatment is at least as positive as in young and middle-aged hypertensive patients. (Hypertens Res 1994; 17 Suppl. I: S47-S50)