Clinical Briefs

By Louis Kuritzky, MD

Old and New Anti-Hypertensive Drugs in Elderly Patients

The swedish trial in old patients with Hypertension (STOP-Hypertension study), published in 1991, was one of the first reports to convincingly establish that beta-blocker and diuretic therapies were efficacious in achieving reductions in cardiovascular morbidity and mortality in elderly patients. STOP-2 is a trial begun in 1992 to compare newer drugs’ (i.e., ACE inhibitors, calcium channel blockers) with conventional’ treatment (i.e., diuretics, beta-blockers). Since conventional treatment has been shown to reduce important endpoints, it was felt unethical to include a placebo group.

During a two-year period, adults (n = 6628) with sustained blood pressure more than 180/105 were randomized to conventional therapy vs. ACE inhibitors or calcium channel blockers (approximately 2000 participants in each group). ACE inhibitors included lisinopril and enalapril, calcium antagonists included felodipine or isradipine, and diuretics/ beta blockers included atenolol, metoprolol, pindolol, HCTZ, or HCTZ/ amiloride combination. Patients were followed up to six years.

Almost half of the patients required more than one drug for blood pressure control, but in the monotherapy-successful groups, equal levels of blood pressure lowering were achieved for each drug treatment.

Fatal cardiovascular events occurred with equal frequency in all drug treatment groups, though frequency of MI and CHF were significantly lower in persons receiving ACE inhibitors than calcium channel blockers. Hansson and colleaguses conclude that older and newer antihypertensive drugs are equally efficacious in treatment of hypertension; therapeutic choice, based upon these data, will rest upon cost, tolerability, and coexisting disorders.

Hansson L, et al. Lancet 1999;354: 1751-1756.