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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical trials show that drug treatment significantly decreases stroke risk in hypertension. The benefit as measured in clinical trials may be affected by changes of blood pressure at entry and by departure from randomised treatment, but the magnitude of such effects is disputed. We have assessed benefit from reduction of stroke using data from the MRC Trial of mild to moderate hypertension, taking these factors into account, and have studied the likely effect of recent guidelines. The original analysis suggested that 850 patients needed treatment for 1 year to prevent one stroke. Under the more conservative of two assumptions made about the effect of treatment, this falls to 695 patients when allowance is made for reduction of stroke in placebo group patients withdrawn and actively treated, to 680 patients when allowance is made for the fall in blood pressure after entry, and to 556 patients with allowance for both. When benefit is assessed in patients whose entry diastolic blood pressure was > or = 100 mm Hg, 557 patients require treatment annually per stroke saved and this is decreased to 360 patients when allowance is made for withdrawal and active treatment of placebo group patients. These results suggest that benefit from reduction of stroke was underestimated in the MRC trial and that this is likely to be present in most trials. Changes to diagnostic criteria for hypertension in new management guidelines are likely to have significant effects on the number of patients treated per stroke prevented.
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PMID:Adjustment of the apparent benefits of treatment on stroke risk in the MRC mild hypertension trial using data from the placebo-treated group. 747 19

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

Results of all major clinical trials on the efficacy of treatment of hypertension provide convincing evidence that judicious treatment of hypertension in a clinical setting and effective control of hypertension in a community setting significantly reduce the rate of morbidity and mortality from stroke. It is especially noteworthy to review the results of some of the trials on prevention of stroke mortality in the elderly. HDFP: Antihypertensive drug treatment reduced the incidence of stroke among the HDFP cohort in the age group 60-69 years as significantly as it did in the younger age group. SHEP: Treatment of isolated systolic hypertension (ISH) reduced the incidence of stroke in the SHEP cohort by 36% in five years. MRC Trial: Similar results were reported by the follow-up of the cohort enrolled in the MRC Trial. The Swedish Study: Antihypertensive treatment reduced significantly the incidence of stroke in this cohort as well.
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PMID:Risk management in stroke prevention: major clinical trials in hypertension. 791 92

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

The MRC trial was a random control comparison of placebo treatment with two active drug regimens: atenolol 50 mg daily and a combined tablet containing hydrochlorothiazide 25 mg and amiloride 2.5 mg. The trial was based on 226 general practices in the U.K. Its primary purpose was to determine whether hypotensive drug treatment in men and women aged 65-74 with systolic pressure in the range 160-209 mmHg and with diastolic pressure below 115 mmHg reduced stroke, coronary heart disease (CHD) and all-cause mortality. A secondary objective was to determine whether outcome differed with the two forms of active treatment. 4,396 patients were randomized: 50% to placebo; 25% each to the two forms of treatment. During the following 5.8 years 25,000 patient-years of experience accumulated. Blood pressure fell in the placebo group, larger falls occurred with the two active treatments. Active treatment (diuretic and beta-blocker groups combined) reduced stroke by 25% (95% CI 3 to 42%), CHD by 19% (-2% to 36%, p = 0.08), cardiovascular events by 17% (2% to 29%). Benefits were clearest for the diuretic regime: a 31% reduction of stroke events, a 44% reduction of CHD and a 35% reduction of cardiovascular events--all significant.
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PMID:MRC trial of treatment in elderly hypertensives. 826 99

We report a short-term double-blind, crossover study of CoQ10 in 8 patients with mitochondrial encephalomyopathies. Four patients had myoclonus epilepsy with ragged-red fibers syndrome, 3 had mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes syndrome, and 1 had chronic progressive external ophthalmoplegia with myopathy. A trend of effectiveness of CoQ10 in several parameters was noted. Fatigability of daily activities was alleviated. The endurance to muscle exercise was augmented. Global muscle strength scored by Medical Research Council scale was increased. The extent of elevation in serum lactate and pyruvate levels after exercise was decreased. However, only the global MRC index score had a statistical significance (p < 0.05). There were no side effects during therapy. The serum CoQ10 levels were significantly lower in patients than in normal controls before CoQ10 treatment and increased significantly after treatment.
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PMID:Coenzyme Q10 treatment in mitochondrial encephalomyopathies. Short-term double-blind, crossover study. 920 60

In those aged 65-85 years, the major causes of death and disability are cardiovascular diseases (myocardial infarction, sudden death and stroke). Clinical trials in elderly patients have demonstrated unequivocally that effective blood pressure reduction in hypertensive patients up to the age of 85 years significantly reduces this mortality and morbidity. The larger trials are referred to as the SHEP trial (chlorthalidone), the STOP trial (beta-blockers and/or diuretics), the MRC Elderly Trial (atenolol or diuretic) and the SYST-EUR trial (nitrendipine). Patients entered into clinical trials are a selected population; those with serious coexisting diseases and with a poor prognosis are usually excluded. For this reason one has to carefully consider whether the results of these trials would provide the best treatment for the next patient the doctor sees who would probably not meet the entry criteria. Elderly hypertensives may fall into one of three categories. The sick elderly with serious disorders such as cancer or dementia have a poor quality of life and a bad prognosis. They should not be given antihypertensive drugs. The medically complicated elderly have serious disorders, which usually require drug therapy and the medical condition and the drugs used in treatment may complicate the choice of antihypertensive drugs. The potential adverse effects of adding another form of drug treatment may outweigh the potential benefits. The fit elderly do derive considerable benefit from adequate blood pressure control and need an effective, well-tolerated antihypertensive drug. The choice of drug to control blood pressure in the elderly is difficult. An effective, well-tolerated antihypertensive with little potential to interact with coexisting disorders and other drugs is needed.
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PMID:Hypertension in the elderly. 983 61

Isolated systolic hypertension is a common disorder in the elderly carrying a high risk of stroke and cardiovascular disease. Isolated systolic hypertension is usually defined as a systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 95 mmHg. The arterial stiffening is the principal cause of increasing systolic pressure in advanced age. It is due to degeneration of the arterial wall and is associated with progressive arterial dilatation. Hypertension in elderly patients is also characterized by increase of peripheral vascular resistance. Due to the wide variability of blood pressure usually seen in old persons, the isolated systolic hypertension is not easy to recognize and final diagnosis requires a long period of observation. The ambulatory blood pressure monitoring proved to be helpful in distinguishing patients with true isolated systolic hypertension from subjects with exaggerated alarm reaction to the pressure measurement. Although the increased risk of cardiovascular and cerebrovascular mortality is well established for isolated systolic hypertension, there has been much debate whether available antihypertensive treatment can prevent or delay cardiovascular and cerebrovascular complications in this condition. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP and MRC trials. All studies have demonstrated that the treatment of isolated systolic hypertension with diuretics or/and beta blockers (frequently used in combination) resulted in a significant reduction in the incidence of stroke and major cardiovascular events. New antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors have also been shown to effectively lower systolic blood pressure in the elderly but the effects on long-term morbidity and mortality are still unknown.
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PMID:[Isolated systolic arterial hypertension in the elderly]. 986 68

Previously we demonstrated that pulse pressure is a strong risk factor for coronary events in male hypertensive subjects in the MRC Mild Hypertension Trial, whereas stroke is best predicted by mean blood pressure. In this study, we have assessed the implications of this finding in the treatment of mild essential hypertension. We examined the relationship between diastolic blood pressure and both coronary disease risk and stroke when these events were predicted by the above blood pressure measures using an empirical linear model and multivariate logistic regression models that contained data from the MRC trial. Under these circumstances, the predicted stroke risk increased progressively with increasing values of diastolic blood pressure, but in both empirical and formal statistical models, the predicted risk of a coronary event exhibited a J-shaped relationship with diastolic blood pressure. These results suggest that if coronary event risk in mild essential hypertension is predicted by pulse pressure then it may increase at low values of diastolic blood pressure, in contrast to stroke risk, which declines continuously as diastolic blood pressure falls within the physiological range. This raises the possibility that different sequelae of hypertension are best predicted by different measures of blood pressure and that the effect of treatment on stroke and coronary events in some circumstances may be discordant.
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PMID:Implications of pulse pressure as a predictor of cardiac risk in patients with hypertension. 1108 65

The effects of antihypertensive treatment on cerebrovascular disease and coronary artery disease (CAD) end points reported in the large-scale national trials have differed. All trials have shown stroke benefit, whereas CAD benefit has not been convincingly demonstrated in any. In three trials, the effects of thiazide- and beta-blocker-based regimens can be directly compared. In the MRC Treatment Trial for Mild Hypertension in Britain, the largest of the trials and the only one to compare these two classes of drugs with each other and with untreated controls, stroke benefit was significantly greater in the thiazide than in the beta-blocker group (p = 0.002). Indeed, the 70% reduction in fatal strokes and 65% reduction in nonfatal strokes suggested an effect on cerebral infarction as well as on cerebral hemorrhage. Opposing trends were found for CAD end points with beta-blockers and thiazides when compared with controls. For coronary events, sudden deaths, and ECG changes of infarction, significant differences were found between the reduced rates for those receiving propranolol and the higher rates for those receiving bendrofluazide. Weak evidence has been put forward by four trials-MRFIT, HDFP, the Oslo trial, and the MRC trial-suggesting that thiazide treatment for those who already have evidence of coronary disease may be harmful. In no case is the evidence conclusive, and it involves only a small (but important) subgroup. In the MRC trial, a nonselective beta-blocker, propranolol, provided greater CAD benefit as measured by the incidence of myocardial infarction, sudden death, and ECG changes, but only in nonsmokers. Hypotheses generated by these trials need further investigation.
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PMID:Beta-blockers vs. thiazides in the treatment of hypertension: a review of the experience of the large national trials. 1152 38


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