Treatment of Hypertension in the Elderly

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In the span of little more than half a year, three major, prospective, placebo-controlled intervention trials against hypertension in the elderly were published, i.e., the Systolic Hypertension in the Elderly Program (SHEP) from the United States in 1991, the Swedish Trial in Old Patients with Hypertension (STOP Hypertension), also in 1991, and the Medical Research Council (MRC) Study in older adults from the United Kingdom in 1992. These trials compared active antihypertensive treatment in elderly patients to placebo, and all found significant benefits from active treatment, particularly against stroke. In the SHEP trial, coronary heart morbidity was also positively affected, and in the STOP Hypertension study total mortality was reduced significantly. In all the three studies, active treatment consisted of diuretics and/or β-blockers, usually given in combination. It is conceivable that novel classes of compounds, e.g., the calcium antagonists, might have shown even better results in the prevention of cardiovascular morbidity and mortality, in view of their neutral metabolic profile and possible antiatherosclerotic effect. Studies are currently in progress to test this possibility, e.g., the STOP-Hypertension-2 study. While the results of such ongoing trials are awaited, it is worth noting that treatment with calcium antagonists in the elderly, e.g., with lacidipine, in several studies has been shown to be remarkably effective and well tolerated. This raises the possibility that results of antihypertensive treatment in the elderly could become even better than those already obtained in the SHEP, STOP-Hypertension, and MRC trials.

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