Q J Med 2000; 93: 700-701
© 2000 Association of Physicians
Correspondence |
Controlling hypertension in the elderly
Sir,
Although it may be true to some extent, that ‘the selection of an antihypertensive drug has more to do with marketing than science’,1 diuretic-based antihypertensive drug regimens2–,4 appear to have a good track record in reducing the probability of subsequent heart failure, risk reductions of the order of approximately 50% being consistently achieved in all three trials, with the proviso that only 66% of STOP-H patients were coprescribed diuretics, as opposed to the patients in the other two trials, in whom diuretics were mandated by the trial protocol in each and every case. Results of the STOP-Hypertension-2 study also show promise for angiotensin-converting-enzyme inhibitors in reducing the risk of subsequent heart failure, certainly in comparison with calcium channel inhibitors,5 indicating, once again, that, in spite of comparable antihypertensive effect, antihypertensive drugs do not have comparable protective action against heart failure. This issue has been brought into sharper focus by the ALLHAT study, in which it was shown that ‘compared with doxazosin, chlorthalidone yields essentially equal risk of CHD (coronary heart disease) death/nonfatal MI (myocardial infarction), but significantly reduces the risk of combined CVD (cardiovascular disease) events, particularly CHF (congestive heart failure), in high-risk hypertensive patients’.6
References
1.
Bulpitt CJ. Controlling hypertension in the elderly. Q J Med2000; 93:203.
2. Amery A, Brixko P, Clement D, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet1985; 1:1349–54.[ISI][Medline]
3. Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with hypertension (STOP-Hypertension). Lancet1991; 338:1281–5.[ISI][Medline]
4. Kostis JB, Davis BR, Cutler J, et al. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA1997; 278:212–16.[Abstract]
5. Hansson L, Lindholm LH, Ekbom T, et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity in the Swedish Trial in Old Patients with Hypertension-2 study. Lancet1999; 354:1751–6.[ISI][Medline]
6.
The ALLHAT officers and coordinators for the ALLHAT Collaborative Research Group. Major cardiovascular events in hypertensive patients randomised to doxazosin vs chlorthalidone. JAMA2000; 283:1967–75.
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