EFFECT OF 2 DIFFERENT THERAPEUTIC APPROACHES ON TOTAL AND CARDIOVASCULAR MORTALITY IN A CARDIOVASCULAR STUDY IN THE ELDERLY (CASTEL)

Although limited numbers of elderly subjects have occasionally been in cluded in population-based studies, only a few studies have been condu cted specifically on elderly hypertensives, and practically none at a population level. We studied 655 hypertensive subjects from a cohort o f 2,254 elderly subjects. The intervention consisted of the creation o f a Hypertension Outpatients' Clinic under our auspices but with compl ete co-operation from general practitioners, randomizing the identifie d hypertensive patients into pre-established therapeutic drug regimens , and early follow-up recording of mortality for 7 years. The drugs us ed were clonidine (n = 61), nifedipine (n = 146) and the fixed combina tion of atenolol+chlorthalidone (n = 144); 304 subjects underwent ''fr ee therapy'' by their personal physicians without any special interven tion. There were 1,404 normotensive subjects. Overall 7-year follow-up mortality was 34.9% in the hypertensive subjects receiving ''free the rapy'', 22.5% in those receiving ''special care'', and 24.2% in the no rmotensives. Cardiovascular mortality was respectively 23.7%, 12.2%, a nd 12.0%. Overall and cardiovascular annual cumulative mortality were significantly lower in the ''special therapy'' than in the ''free ther apy'' group. The fixed combination of atenolol and chlorthalidone redu ced mortality below that of the normotensives, independent of other ca rdiovascular risk factors.