Comparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension - 2

Background The benefits of treating hypertension in elderly diabetic patien ts, in terms of achieving reductions in cardiovascular morbidity and mortal ity, have been documented in several recent prospective trials. There has, however, been some controversy regarding the effect of different antihypert ensive drugs on the frequency of myocardial infarction in this group of pat ients. Design STOP Hypertension-5 was a prospective, randomized, open trial with b linded endpoint evaluation. Methods We studied 6614 elderly patients aged 70-84 years; 719 of them had diabetes mellitus at the start of the study (mean age 75.8 years). Patients were randomly assigned to one of three treatment strategies: conventional antihypertensive drugs (diuretics or beta -blockers), calcium antagonists, or angiotensin converting enzyme (ACE) inhibitors. Results Reduction in blood pressure was similar in the three treatment grou ps of diabetics. The prevention of cardiovascular mortality was also simila r; the frequency of this primary endpoint did not differ significantly betw een the three groups. There were, however, significantly fewer (P = 0.025) myocardial infarctions during ACE inhibitor treatment (n = 17) than during calcium antagonist treatment (n = 32; relative risk 0.51, 95% confidence in terval 0.28-0.92); but a (non-significant) tendency to more strokes during ACE inhibitor treatment (n = 34 compared with n = 29; relative risk 1.16, 9 5%, confidence interval 0.71-1.91). Conclusion Treatment of hypertensive diabetic patients with conventional an tihypertensive drugs (diuretics, beta -blockers, or both) seemed to be as e ffective as treatment with newer drugs such as calcium antagonists or ACE i nhibitors. J Hypertens 18:1671-1675 (C) 2000 Lippincott Williams & Wilkins.