Treatment of hypertension in the elderly

Abstract

Recent clinical trials in the elderly: The results of three major intervention trials against hypertension in the elderly were published in 1991 and 1992. The studies were the Systolic Hypertension in the Elderly Program (SHEP) from the United States, the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) from Sweden and the Medical Research Council (MRC) trial in older adults. In the SHEP trial the recruitment criteria were based on isolated systolic hypertension, whereas the STOP-Hypertension trial and the MRC trial recruited patients with both systolic and diastolic hypertension. In all three trials diuretics and/or beta-blockers (frequently used in combination) formed the basis of active treatment, the patients being randomly allocated either to active treatment or to a placebo. Therapeutic results: The main results for all three trials showed clear benefits from actively lowering elevated arterial pressure in patients aged 60 years or over. In particular, fatal and non-fatal strokes were significantly reduced. In the SHEP trial fatal and non-fatal myocardial infarction and coronary disease were also reduced, and in the STOP trial total mortality was markedly reduced.