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

It is well established that hypertensive patients benefit from drug treatment of their disorder. In recent years three major out-come studies of antihypertensive treatment in elderly hypertensives have shown substantial benefits, i.e. a reduction in the risk of stroke and other cardiovascular mortality and morbidity. In all these studies beta-blockers and/or diuretics were used in comparison with placebo. Newer therapeutic alternatives have, however, at least theoretically, many advantages which could result in further improvements in prognosis. The initial Swedish Trial in Old Patients with Hypertension (STOP-Hypertension 1) was conducted in men and women aged 70-84 years. STOP-Hypertension 2 will evaluate the therapy used in STOP-Hypertension 1 against therapy based on either ACE-inhibitors (enalapril and lisinopril) or on calcium antagonists (isradipine and felodipine), using the PROBE design (Prospective, Randomised, Open, Blinded Endpoint evaluation). The primary aim will be to assess the effect on cardiovascular mortality. Statistical calculations indicate that 6,600 patients, followed for four years will be needed (2p < 0.05, power 90%) to obtain significance if there is a 25% difference between the new and the established therapy. Patients in primary health care (300 centres) will be included if their supine blood pressure is > or = 180/105 mmHg (and/or). Recruitment of patients started in September 1992 and so far more than 100 patients/week have been included.
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PMID:STOP-Hypertension 2: a prospective intervention trial of "newer" versus "older" treatment alternatives in old patients with hypertension. Swedish Trial in Old Patients with Hypertension. 818 Jul 29

Cardiovascular disease remains the major cause of death in elderly people, with hypertension the main treatable risk factor. Despite this there has been little consensus with regard to assessment or treatment of the elderly hypertensive patient. Several recent large intervention trials have shown blood pressure (BP) reduction in elderly patients with combined and isolated systolic hypertension using thiazide diuretics or beta-blockers significantly reduces cardiovascular morbidity and mortality. However, only the STOP-Hypertension Trial has shown a reduction in total mortality with active treatment. Patients under 80 years with an SBP > or = 160 mmHg and DBP > or = 90 mmHg or SBP > or = 160 mmHg and DBP < 90 mmHg should be considered for anti-hypertensive therapy, initially using non-pharmacological methods. Thiazide diuretics and beta-blockers remain first-line pharmacological therapy, the long-term benefits of other types of anti-hypertensive agent have yet to be assessed. In general the negative attitudes to treating hypertension in the elderly can no longer be upheld, although in certain sub-groups the benefits of treatment are as yet unproven.
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PMID:Hypertension and the elderly. 820 66

Several studies have demonstrated an increased risk of cardiovascular disease (CVD) in relation to high blood pressure in elderly patients aged below 70-75, whereas the risk seemed to decline with age in the older elderly. Early studies on the effect of treatment of mild to moderate hypertension in the elderly indicated (but did not convincingly show) a reduction of CVD. In the 1980s, both the EWPHE trial (European Working Party on High Blood Pressure in the Elderly) and the HEP study (The Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care) provided evidence of the benefit of treating high blood pressure in the elderly, at least up to the age of 70-74. These results have lately been confirmed by three major trials SHEP (Systolic Hypertension in the Elderly Program), STOP (Swedish Trial in Old Patients with Hypertension) and MRC (Medical Research Council), also including older patients (STOP) and those with isolated systolic hypertension (SHEP). This satisfactory effect was not impaired by a low tolerability of the drugs used (beta-blockers and diuretics). In conclusion, drug treatment with beta-blockers and diuretics in hypertensive men and women aged 70 and above confers highly significant and clinically relevant reductions in cardiovascular (especially stroke) morbidity and mortality. The clinical implication of this is that blood pressure lowering therapy should be considered in elderly hypertensives, at least up until they are 80. It should also be remembered that elderly hypertensives often have other diseases as well and that the drug treatment should be adjusted accordingly.
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PMID:Hypertension in the elderly. 826 94

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.
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PMID:Treatment of hypertension in the elderly. 837 32

Treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective according to the analyses of the results of the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). The cost-effectiveness ratios are low and of the same magnitude for both men and women. The results with respect to reduced risk of cardiovascular disease in STOP Hypertension are also supported by several other studies using the same groups of drugs. The more modern drugs (calcium antagonists, alpha 1 blockers, and ACE inhibitors) have not proven their efficacy in the reduction of cardiovascular events in prospective studies of primary hypertension. It has, however, been shown that they lower blood pressure well also in the elderly and that they are cost-effective among the elderly if treatment with beta-receptor blockers and/or diuretics is contraindicated, provided that they lower the incidence of cardiovascular disease to the same extent as do beta-receptor blockers and diuretics. Studies tackling this latter question are under way, also in the elderly.
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PMID:Cost-benefit aspects of treatment of hypertension in the elderly. 853 36

Treatment of hypertension in the elderly has become not only accepted but also a highly ethical, effective and compelling procedure following the many clearly positive reports on the benefits of lowering elevated arterial pressure in elderly patients. So far most intervention studies in elderly hypertensive patients have used diuretics or beta-blockers or the two in combination as the moiety by which blood pressure has been lowered. However, from a theoretical point of view, more novel therapies could offer advantages that would translate into an even better reduction of cardiovascular morbidity and mortality than has been obtained with the traditional antihypertensive therapies used so far. Some of the studies in elderly hypertensives that are in progress using angiotensin converting enzyme inhibitors or calcium antagonists as the main therapies, e.g. the STOP-Hypertension-2 Study and the Syst-Eur Study, will be briefly reviewed here as will the large data base on urapidil, a dual action antihypertensive drug used in the treatment of elderly hypertensives. By careful evaluation of the effects of novel antihypertensive drugs, and the already existing data base on urapidil in elderly hypertensive patients, it is likely that still better reduction of risk can be obtained in the elderly hypertensives by the use of more novel therapies than diuretics and beta-blockers.
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PMID:Characteristics of an ideal antihypertensive therapy for elderly hypertensives. 853 46

Antihypertensive treatment with diuretics and/or beta-blockers lowers stroke and coronary heart disease morbidity and mortality. However, although the newer antihypertensives induce effective control of blood pressure and regression of hypertensive organ damage, it has not been proven whether they reduce mortality. Ongoing clinical trials such as STOP II, CAPPP, NORDIL, INSIGHT, ALLHAT and LIFE test whether antihypertensive regimens with ACE-inhibitor, calcium-blocker, alpha-blocker and Angiotensin II-antagonist are equally good or possibly even better than diuretics and beta-blockers in preventing cardiovascular complications. The HOT trial clarifies how much the diastolic blood pressure should be lowered, and whether a small dose of aspirin has a protective effect when combined with optimal control of blood pressure. These studies should give better guidelines for the treatment of hypertension.
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PMID:[Status of ongoing controlled clinical trials on hypertension]. 1535 9

Several studies have been published recently on the effect of calcium-antagonists in the treatment of hypertension and heart failure. Except for an American case-control study, in which negative results may have been caused by selection bias, other studies show that calcium-antagonists have a positive effect. They appear to reduce cardiovascular complications, lower mortality and slow down the progression of atherosclerosis. However, large trials of adequate design and force are in progress (STOP II, NORDIL, HOT, INSIGHT, ALLHAT). It is hoped that the results of these trials will clarify whether calcium-antagonist are warranted in the treatment of hypertension and associated cardiovascular disease.
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PMID:[Calcium antagonists in the treatment of hypertension and heart failure. A comment to recently published results of clinical trials]. 855 44

Hypertension occurs in 50% of the elderly persons in industrialized societies. This disorder of the regulation of the arterial blood pressure has different manifestations in different age groups. The young hypertensive usually has an increase in cardiac output and a normal peripheral vascular resistance. The elderly patient with hypertension exhibits a decreased cardiac output and an increased peripheral vascular resistance. In the elderly hypertensive there is a progressive anteriolar narrowing and there is hardening of the largest arteries. The vascular disease that contributes to the hypertension in the elderly also causes hypoperfusion of the target organs. During the aging process there is a decrease in cardiac output, glomerular filtration rate, vital capacity, renal plasma flow and maximal cardiac rate. There are changes in the kidneys and the liver that influence the way different medications are handled by the body. The main findings of the Australian, EWPHE, Coope & Warrender, SHEP, STOP-HYP and MRC studies of hypertension in the elderly have been summarized. The intervention studies have proven that the treatment of hypertension in the elderly patient is efficacious and decreases the mortality and morbidity due to coronary and cerebrovascular events. The pharmacologic agents available for the treatment of hypertension in the elderly are the diuretics, beta blockers, vasodilators, calcium-channel blockers, adrenergic blockers and angiotensin converting enzyme inhibitors. The morbidity and mortality benefits derived from antihypertensive trials are greater for the older than for the younger patients. The pharmacologic antihypertensive agents to be used in older patients will also depend upon the presence or not of associated illnesses in which some agents might be harmful or contraindicated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hypertension in old age]. 858 23

Drug treatment with beta-blockers and diuretics in hypertensive men and women aged 70 and above confers highly significant and clinically relevant reductions in cardiovascular (especially stroke) morbidity and mortality. This satisfactory effect is not impaired by a low tolerability of the drugs used. Furthermore, treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective. In STOP-Hypertension the cost-effectiveness ratios were low and of the same magnitude for both men and women. The clinical implication of this is that blood pressure lowering therapy should be considered in elderly hypertensives, at least up until they are 80 years old. It should also be remembered that elderly patients often have other diseases than hypertension and that the drug treatment should be adjusted accordingly, e.g. by using a calcium antagonist or an ACE inhibitor, when indicated.
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PMID:Antihypertensive treatment in the elderly. 874 33


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