E. Casiglia et al., EFFECT OF 2 DIFFERENT THERAPEUTIC APPROACHES ON TOTAL AND CARDIOVASCULAR MORTALITY IN A CARDIOVASCULAR STUDY IN THE ELDERLY (CASTEL), Japanese Heart Journal, 35(5), 1994, pp. 589-600
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.