Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study
L. Hansson et al., Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study, LANCET, 354(9192), 1999, pp. 1751-1756
Citations number
15
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background The efficacy of new antihypertensive drugs has been questioned.
We compared the effects of conventional and newer antihypertensive drugs on
cardiovascular mortality and morbidity in elderly patients.
Methods We did a prospective, randomised trial in 6614 patients aged 70-84
years with hypertension (blood pressure greater than or equal to 180 mm Hg
systolic, greater than or equal to 105 mm Hg diastolic, or both). Patients
were randomly assigned conventional antihypertensive drugs (atenolol 50 mg,
metoprolol 100 mg, pindolol 5 mg, or hydrochlorothiazide 25 mg plus amilor
ide 25 mg daily) or newer drugs (enalapril 10 mg or lisinopril 10 mg, or fe
lodipine 2.5 mg or isradipine 2-5 mg daily). We assessed fatal stroke, fata
l myocardial infarction, and other fatal cardiovascular disease. Analysis w
as by intention to treat.
Findings Blood pressure was decreased similarly in all treatment groups. Th
e primary combined endpoint of fatal stroke, fatal myocardial infarction, a
nd other fatal cardiovascular disease occurred in 221 of 2213 patients in t
he conventional drugs group (19.8 events per 1000 patient-years) and in 438
of 4401 in the newer drugs group (19.8 per 1000; relative risk 0.99 [95% C
I 0.84-1.16], p=0.89). The combined endpoint of fatal and non-fatal stroke,
fatal and non-fatal myocardial infarction, and other cardiovascular mortal
ity occurred in 460 patients taking conventional drugs and in 887 taking ne
wer drugs (0.96 [0.86-1.08], p=0.49).
Interpretation Old and new antihypertensive drugs were similar in preventio
n of cardiovascular mortality or major events. Decrease in blood pressure w
as of major importance for the prevention of cardiovascular events.