Fast track — ArticlesRandomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study
Introduction
The benefits of treating hypertension in elderly people through decrease of cardiovascular morbidity and mortality have been well documented in prospective intervention studies.1, 2, 3, 4, 5, 6, 7
In the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) study,4 a double-blind, randomised, controlled trial, 1627 elderly patients with hypertension were assigned active antihypertensive treatment (one of three β-blockers or a fixed-ratio combination of hydrochlorothiazide and amiloride) or placebo. Active treatment lowered endpoint rates significantly compared with placebo: fatal and non-fatal strokes by 47%, major cardiovascular events (all strokes, all myocardial infarctions, and other cardiovascular mortality) by 40%, and total mortality by 43%.
Before publication of the results of STOP-Hypertension in 1991, questions had been raised about the usefulness of newer antihypertensive drugs, specifically angiotensinconverting-enzyme (ACE) inhibitors and calcium antagonists, in the prevention of cardiovascular morbidity in elderly patients with hypertension. We therefore designed the STOP-Hypertension-2 study8, 9 to compare cardiovascular mortality during treatment with conventional antihypertensive drugs (diuretics, β-blockers, or both) with that during treatment with newer drugs (ACE inhibitors or calcium antagonists). We did not include a long-term placebo control group for ethical reasons. We aimed also to compare the three treatments for effect on cardiovascular mortality.
Section snippets
Study population
From Sept 1, 1992, to Dec 30, 1994, we enrolled 6628 men and women in 312 health centres in Sweden (figure 1) who had hypertension (blood pressure ≥ 180 mm Hg systolic, ≥ 105 mm Hg diastolic, or both), aged 70–84 years. The only difference in inclusion criteria between this trial and the STOP-Hypertension trial was that patients with isolated systolic hypertension could be included in STOP-Hypertension-2, based on previous positive findings in patients with isolated systolic hypertension
Results
14 patients were excluded because they were outside the age range of 70–84 years (figure 1). The mean number of patients per trial centre was 21·2; more than 150 centres randomised 25 patients or more. No patient was lost to follow-up and no patient refused to continue in the study. 33 249 patient-years were accumulated, 11 150 in the conventional drugs group, 11 048 in the ACE inhibitors group, and 11 051 in the calcium antagonists group; 369, 380, and 362 patients respectively, died. Baseline
Discussion
This trial was longer than and recruited more than four times as many patients as the STOP-Hypertension study.4 The treatment groups in the two studies were similar for all important features, which makes comparisons justified.
All three therapies showed similar efficacy in prevention of cardiovascular mortality and major morbidity; this finding accords with those of Captopril Prevention Project (CAPPP).11 In CAPPP, there was some suggestion that an ACE-inhibitor-based regimen might be less
References (15)
- et al.
Morbidity and mortality in the Swedish trial in Old Patients with Hypertension (STOP-Hypertension)
Lancet
(1991) - et al.
Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension
Lancet
(1997) - et al.
Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension
Lancet
(1999) - et al.
Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial
Lancet
(1998) - et al.
Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial
Lancet
(1985) - et al.
Randomised trial of treatment of hypertension in elderly patients in primary care
BMJ
(1986) Prevention of stroke by hypertensive drug therapy in older persons with isolated systolic hypertension: final results of the systolic hypertension in the elderly program
JAMA
(1991)
Cited by (1359)
Management of high blood pressure in primary cardiovascular prevention for old and very old adults
2022, NPG Neurologie - Psychiatrie - GeriatrieAntihypertensive treatment and risk of cancer: an individual participant data meta-analysis
2021, The Lancet OncologyAntihypertensive treatment targets in older adults: an unsolved dilemma
2023, European Journal of Preventive CardiologyThe Combination of Beta-Blockers and ACE Inhibitors Across the Spectrum of Cardiovascular Diseases
2023, Cardiovascular Drugs and Therapy
Members listed at end of paper