Old and new antihypertensive drugs have similar efficacy in terms of reducing cardiovascular mortality and morbidity in elderly patients, according to a new trial published this week.
The STOP-2 study (Swedish Trial in Old Patients with Hypertension 2), was a prospective, randomised trial comparing conventional therapy (thiazide or beta-blocker) and newer therapy (ACE inhibitor or calcium channel blocker). It invoved 6,614 patients aged 70 to 84.
Blood pressure decreased similarly in all groups. All therapies showed similar efficacy in prevention of cardiovascular mortality and major morbidity. The authors comment that choice of treatment will, therefore, be related to other factors, such as cost, side effects and co-existing disorders (Lancet 1999;354:1751).
Discussing the trial in an accompanying leading article, (Ibid, p1744), Dr Martin Kendall (clinical pharmacologist, Queen Elizabeth hospital, Birmingham) says that STOP-2 has shown convincingly that, among older hypertensive patients, the risk of a major cardiovascular event is the same whether patients are given conventional or newer therapy. But he notes the risk of adverse effects with the various treatments and suggests that clinicians should consider which patients to treat. He says: "Antihypertensive treatment is given to lower the risk of cardiovascular events in the long-term. Many 78-year-olds will have serious life-shortening disorders, such as cancer, dementia or end-stage respiratory disease, so for most of these people antihypertensive therapy would be inappropriate. Others at this age have serious concomitant disorders and are already on several drugs. The prescriber, and perhaps the patient, will need to consider the impact of antihypertensive therapy on compliance, the risk of falls, and the potential for additional adverse events." Dr Kendall emphasises that, for the fit, elderly hypertensive patient, drug treatment is clearly indicated.