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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.
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PMID:Treatment of hypertension in the elderly--what have we learned from the recent trials? 129 75

The already strong case for drug treatment of hypertensive patients aged over 60 has been reinforced by the reports on the SHEP, STOP, and, to a lesser extent, MRC trials. SHEP showed benefit in "isolated systolic" hypertension, mainly in relation to stroke, but with a strong trend towards also reducing myocardial infarction. SHEP demonstrated advantages from low-dose chlorthalidone, especially if hypokalemia was prevented. STOP in patients aged 70-84 at entry demonstrated a reduction in stroke and all-cause mortality but not in myocardial infarction; benefit was apparent in women as well as men. The MRC trial, in subjects over 65, many of whom had "isolated systolic" hypertension, found a reduction in stroke but not in coronary events or all-cause mortality. Extensive cross-contamination of allocated treatment groups restricted worthwhile evaluation of different drug regimens in MRC. Potential benefits from antihypertensive drug treatment in old people are substantial but are in danger of being discredited because of intemperate and inaccurate claims.
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PMID:The case for antihypertensive drug treatment in subjects over the age of 60. 129 77

The Swedish trial in old patients with hypertension (STOP-Hypertension) is a multicentre, randomized, double-blind study of beta-blockers/diuretics versus placebo in old hypertensives. Primary end-points are stroke and myocardial infarction (fatal and non-fatal) as well as other cardiovascular mortality. To evaluate the logistics of STOP-Hypertension, a pilot study was carried out. All patients aged 70-84 years in 31 centres were consecutively registered in a log-book. Altogether 4668 patients were screened: 41.5% had previously been treated for hypertension and 13.5% had blood pressures greater than or equal to 180/105 mmHg. Thus, 55% were 'hypertensive'. In all, 465 patients (18% of the 'hypertensive' patients) started a 3-month washout period (previously treated, n = 396) or a 4-week run-in period (previously untreated, n = 69) period. The most frequent reasons for not starting the run-in/washout were other indications for treatment with beta-blockers/diuretics (13%), unwillingness to participate (8%) or isolated systolic hypertension (4%). The pilot study was evaluated after 1 year: 89 patients (1.9%) had been randomized, 66 patients (1.4%) were still in the run-in/washout period and the majority of the remaining patients were not randomized because they had not reached the inclusion blood pressure (greater than or equal to 180 mmHg systolic and/or greater than or equal to 105 mmHg diastolic) following withdrawal of their antihypertensive medication. During the run-in/washout period there were few serious clinical events: one case of myocardial infarction, three patients had strokes (two fatal), 10 developed congestive heart failure, three tachyarrhythmia and two pneumonia (one fatal).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:STOP-Hypertension--preliminary communication from the pilot study of the Swedish Trial in Old Patients with Hypertension. 289 71

Specific antihypertensive therapy has been in common clinical use for about four decades. During this relatively short period of time remarkable progress has been made in many regards. The value of lowering elevated arterial pressure has been documented in a number of intervention trials. Initially, such studies comprised patients with malignant hypertension only, but later large-scale studies have comprised patients with non-malignant forms of hypertension. At the same time numerous new pharmacological principles have been taken into clinical use in the treatment of hypertension. It is the purpose of this brief review to sum up some of the important steps that have been taken in this area during previous decades and to try to evaluate the status of current therapies for hypertension. Special emphasis will be given to some of the remaining issues and questions that are currently under investigation, such as the place of novel therapies, e.g. calcium antagonists and ACE-inhibitors, and the issue of the level to which blood pressure should be lowered in order to extract the maximum benefit of antihypertensive treatment. Some of the ongoing large-scale intervention trials in hypertension, e.g. the CAPPP Study, the NORDIL Study, the HOT Study and the STOP Hypertension-2 study, will be reviewed.
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PMID:Status of current therapies for hypertension. 758 83

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 beta-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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PMID:Treatment of hypertension in the elderly. 760 9

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. (MRC trial.) The three trials all compared active antihypertensive treatment, mainly consisting of diuretics or beta-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 and 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 the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. It could be argued that novel antihypertensive compounds offer equal or better results than the ones obtained with beta blockers and/or diuretics. Angiotensin converting enzyme inhibitors and calcium antagonists are currently being compared with diuretics and beta-blockers in the STOP-Hypertension-2 study which prospectively evaluates morbidity and mortality in hypertensive patients aged 70-84 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of hypertension in the elderly with special reference to urapidil. 780 12

beta-blockers are one of the first-line therapeutic alternatives for the treatment of hypertension. Their role in this position appears stronger than earlier in view of the results of the three large intervention trials in elderly hypertensive patients (SHEP, STOP-Hypertension and MRC), which all used beta-blockers as one of their therapeutic alternatives. The secondary preventive effect of beta-blockers against coronary heart disease is well established, whereas convincing evidence from placebo-controlled trials regarding their primary preventive effect still is missing. In animal studies beta-blockers have been shown to prevent the development of coronary atherosclerosis and some of the newer agents have been shown to be markedly effective against experimentally induced myocardial ischemia. For reasons such as these, it appears safe to predict that beta-blockers will continue to play an important therapeutic role also in 1993 and beyond.
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PMID:The place of beta-blockers in the treatment of hypertension in 1993. 790 76

There is ample evidence that antihypertensive therapy prevents strokes, congestive heart failure, and other blood pressure-related complications, but most trials have failed to show a reduction in coronary events and mortality. Recently, the Systolic Hypertension in the Elderly Program (SHEP) showed a reduction in MIs and other coronary events in older patients with moderate to severe ISH. Cardiovascular mortality was also reduced and there was a trend toward a reduction in coronary events in the Swedish STOP-Hypertension Trial and the British MRC Trial in Older Patients. These studies have in common the use of diuretics and/or beta blockers. Although there are no similar long-term data with calcium channel blockers and ACE inhibitors, they will be the drugs of choice for many patients, based on individual responses and accompanying medical conditions.
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PMID:First-line therapy for hypertension: different patients, different needs. 790 5

The only antihypertensive treatment regimen with documented effect on morbidity and mortality from stroke and coronary heart disease is based on diuretics and/or beta-blockers. However, new antihypertensive drugs are now widely used. These compounds may also prevent cardiovascular complications, but, as yet, this has not been proven. The clinical trials of the 1990s such as STOP II, CAPPP and NORDIL will test whether antihypertensive treatment with ACE-inhibitors and calcium-blockers are more effective than diuretics and beta-blockers in preventing cardiovascular complications. Also, a large-scale study (HOT) is being undertaken to examine how far diastolic blood pressure should be treated, and whether a small dose of aspirin has a protective effect when combined with good control of blood pressure. These studies will hopefully lead to better guidelines for the future treatment of hypertension.
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PMID:[Can treatment of hypertension prevent myocardial infarction? New controlled clinical trials are proposed]. 809 58

During 1991 and 1992, three major interventional 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 (MRC) Trial of Treatment of Hypertension in Older Adults. The three trials all compared active antihypertensive treatment, mainly diuretics or beta-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 multicentered, prospective, and included randomization. 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 one of the trials, total mortality was also positively affected. Thus, in the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. On the basis of these trials, it is apparent that antihypertensive treatment with low-dose thiazides or beta-blockers, or the two in combination, can produce highly beneficial results in elderly patients, including a reduction in the incidence of stroke and other cardiovascular events as well as in total mortality. Furthermore, special analyses indicate that the cost:benefit aspects of such treatment is at least as positive as in young and middle-aged hypertensive patients.
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PMID:Future goals for the treatment of hypertension in the elderly with reference to STOP-Hypertension, SHEP, and the MRC trial in older adults. 809 6


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