Skip to main content

Clinical Trials of Hypertension in the Older Patient

  • Chapter

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

Abstract

Outcomes trials have established the benefit of treating hypertension in the older patient but not the very elderly (1,2). These trials are reviewed because they represent the cornerstone of care of these patients. Subset analyses of early studies suggested a potential benefit for reducing blood pressure (BP) in older patients (38).

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mulrow CD, Cornell JA, Herrera CR, Kadri A, Farnett L, Aguilar C. Hypertension in the elderly. Implications and generalizability of randomized trials. JAMA 1994;272:1932–1938.

    Article  PubMed  CAS  Google Scholar 

  2. Gueyffier F, Bulpitt C, Boissel JP, et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 1999;353:793–796.

    Article  PubMed  CAS  Google Scholar 

  3. Effects of treatment on morbidity in hypertension. 3. Influence of age, diastolic pressure, and prior cardiovascular disease; further analysis of side effects. Circulation 1972;45:991–1004.

    Google Scholar 

  4. Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979;242:2572–2577.

    Google Scholar 

  5. Treatment of mild hypertension in the elderly. A study initiated and administered by the National Heart Foundation of Australia. Med J Aust 1981;2:398–402.

    Google Scholar 

  6. Birkenhäger WH, de Leeuw PW, Amery A, Staessen J. Treatment of hypertension in the elderly. Cardiovasc Drugs Ther 1988;2:275–279.

    Article  PubMed  Google Scholar 

  7. Smith WM. The case for treating hypertension in the elderly. Am J Hypertens 1988;1(3 pt 3):173S–178S.

    PubMed  CAS  Google Scholar 

  8. Beard K, Bulpitt C, Mascie-Taylor H, O’Malley K, Sever P, Webb S. Management of elderly patients with sustained hypertension. BMJ 1992;304:412–416.

    PubMed  CAS  Google Scholar 

  9. Hansson L, Hedner T, Dahlöf B. Prospective randomized open blinded end-point (PROBE) study. A novel design for intervention trials. Prospective Randomized Open Blinded End-Point. Blood Press 1992;1:113–119.

    PubMed  CAS  Google Scholar 

  10. Amery A, Birkenhäger W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1985;1:1349–1354.

    Article  PubMed  CAS  Google Scholar 

  11. Prisant LM, Carr A A. Overview of the findings of the European Party on High Blood Pressure in the Elderly. Geriatr Med Today 1990;9:35–38.

    Google Scholar 

  12. Carter AB. Hypotensive therapy in stroke survivors. Lancet 1970;1:485–489.

    Article  PubMed  CAS  Google Scholar 

  13. Effect of antihypertensive treatment on stroke recurrence. Hypertension-Stroke Cooperative Study Group. JAMA 1974;229:409–418.

    Google Scholar 

  14. Sprackling ME, Mitchell JR, Short AH, Watt G. Blood pressure reduction in elderly: a randomised controlled trial of methyldopa. Br Med J (Clin Res Ed) 1981;283:1151–1153.

    CAS  Google Scholar 

  15. Coope J, Warrender TS. Randomised trial of treatment of hypertension in elderly patients in primary care. Br Med J (Clin Res Ed) 1986;293:1145–1151.

    CAS  Google Scholar 

  16. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991;265:3255–3264.

    Google Scholar 

  17. Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Arch Intern Med 1994;154:2154–2160.

    Article  PubMed  CAS  Google Scholar 

  18. Kostis JB, Davis BR, Cutler J, et al. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group. JAMA 1997;278:212–216.

    Article  PubMed  CAS  Google Scholar 

  19. Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA 1996;276:1886–1892.

    Article  PubMed  CAS  Google Scholar 

  20. Dahlof B, Lindholm LH, Hansson L, Schersten B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hyper-tension). Lancet 1991;338:1281–1285.

    Article  PubMed  CAS  Google Scholar 

  21. Ekbom T, Dahlöf B, Hansson L, Lindholm LH, Scherstén B, Wester PO. Antihypertensive efficacy and side effects of three beta-blockers and a diuretic in elderly hypertensives: a report from the STOP-Hypertension study. J Hypertens 1992;10:1525–1530.

    PubMed  CAS  Google Scholar 

  22. Prisant LM. Should beta blockers be used in the treatment of hypertension in the elderly? J Clin Hypertens (Greenwich) 2002;4:286–294.

    Article  CAS  Google Scholar 

  23. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992;304:405–412.

    Google Scholar 

  24. Kendall MJ. Treatment of hypertension in older adults. BMJ 1992;304:639.

    PubMed  CAS  Google Scholar 

  25. Mitchell AB. MRC trial of treating hypertension in older adults. BMJ 1992;304:1631.

    PubMed  CAS  Google Scholar 

  26. Swedberg K. MRC trial of treating hypertension in older adults. BMJ 1992;304:1630–1631.

    PubMed  CAS  Google Scholar 

  27. Tuomilehto J. MRC trial of treating hypertension in older adults. BMJ 1992;304:1631.

    Article  PubMed  CAS  Google Scholar 

  28. Casiglia E, Spolaore P, Mormino P, et al. The CASTEL project (Cardiovascular Study in the Elderly): protocol, study design, and preliminary results of the initial survey. Cardiologia 1991;36:569–576.

    PubMed  CAS  Google Scholar 

  29. Casiglia E, Spolaore P, Mazza A, et al. Effect of two different therapeutic approaches on total and cardiovascular mortality in a Cardiovascular Study in the Elderly (CASTEL). Jpn Heart J 1994;35:589–600.

    PubMed  CAS  Google Scholar 

  30. Gong L, Zhang W, Zhu Y, et al. Shanghai trial of nifedipine in the elderly (STONE). J Hypertens 1996;14:1237–1245.

    Article  PubMed  CAS  Google Scholar 

  31. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997;350:757–764.

    Article  PubMed  CAS  Google Scholar 

  32. Tuomilehto J, Rastenyte D, Birkenhäger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999;340:677–684.

    Article  PubMed  CAS  Google Scholar 

  33. Birkenhager WH, Forette F, Seux ML, Wang JG, Staessen JA. Blood pressure, cognitive functions, and prevention of dementias in older patients with hypertension. Arch Intern Med 2001;161:152–156.

    Article  PubMed  CAS  Google Scholar 

  34. Forette F, Seux ML, Staessen JA, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998;352:1347–1351.

    Article  PubMed  CAS  Google Scholar 

  35. Forette F, Seux ML, Staessen JA, et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med 2002;162:2046–2052.

    Article  PubMed  Google Scholar 

  36. Liu L, Wang JG, Gong L, Liu G, Staessen JA. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens 1998;16(12 pt 1):1823–1829.

    Article  PubMed  CAS  Google Scholar 

  37. Hansson L, Lindholm LH, Ekbom T, 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 1999;354:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  38. Lindholm LH, Hansson L, Ekbom T, et al. Comparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension-2. STOP Hypertension-2 Study Group. J Hypertens 2000;18:1671–1675.

    Article  PubMed  CAS  Google Scholar 

  39. Kuramoto K. Treatment of elderly hypertensives in Japan: National Intervention Cooperative Study in Elderly Hypertensives. The National Intervention Cooperative Study Group. J Hypertens Suppl 1994;12:S35–S40.

    PubMed  CAS  Google Scholar 

  40. Randomized double-blind comparison of a calcium antagonist and a diuretic in elderly hypertensives. National Intervention Cooperative Study in Elderly Hypertensives Study Group. Hypertension 1999;34:1129–1133.

    Google Scholar 

  41. Wing LM, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin-converting—enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003;348:583–592.

    Article  PubMed  CAS  Google Scholar 

  42. Australian comparative outcome trial of angiotensin-converting enzyme inhibitor-and diuretic-based treatment of hypertension in the elderly (ANBP2): objectives and protocol. Management Committee on behalf of the High Blood Pressure Research Council of Australia. Clin Exp Pharmacol Physiol 1997;24:188–192.

    Google Scholar 

  43. Lithell H, Hansson L, Skoog I, et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003;21:875–886.

    Article  PubMed  CAS  Google Scholar 

  44. Malacco E, Mancia G, Rappelli A, Menotti A, Zuccaro MS, Coppini A. Treatment of isolated systolic hypertension: the SHELL study results. Blood Press 2003;12:160–167.

    Article  PubMed  CAS  Google Scholar 

  45. Malacco E, Gnemmi AE, Romagnoli A, Coppini A. Systolic hypertension in the elderly: long-term lacidipine treatment. Objective, protocol, and organization. SHELL Study Group. J Cardiovasc Pharmacol 1994;23(suppl 5):S62–S66.

    PubMed  CAS  Google Scholar 

  46. Bulpitt CJ, Fletcher AE, Amery A, et al. The Hypertension in the Very Elderly Trial (HYVET). J Hum Hypertens 1994;8:631–632.

    PubMed  CAS  Google Scholar 

  47. Bulpitt CJ, Fletcher AE, Amery A, et al. The Hypertension in the Very Elderly Trial (HYVET). Rationale, methodology and comparison with previous trials. Drugs Aging 1994;5:171–183.

    PubMed  CAS  Google Scholar 

  48. Bulpitt C, Fletcher A, Beckett N, et al. Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial. Drugs Aging 2001;18:151–164.

    Article  PubMed  CAS  Google Scholar 

  49. Bulpitt CJ, Beckett NS, Cooke J, et al. Results of the pilot study for the Hypertension in the Very Elderly Trial. J Hypertens 2003;21:2409–2417.

    Article  PubMed  CAS  Google Scholar 

  50. Grimm RH Jr, Margolis KL, Papademetriou VV, et al. Baseline Characteristics of Participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension 2001;37:19–27.

    PubMed  CAS  Google Scholar 

  51. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. JAMA 2000;283:1967–1975.

    Google Scholar 

  52. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981–2997.

    Google Scholar 

  53. Diuretic vs α-blocker as first-step antihypertensive therapy: final results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension 2003;42:239–246.

    Google Scholar 

  54. Cushman WC, Ford CE, Cutler JA, et al. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich) 2002;4:393–404.

    Article  Google Scholar 

  55. Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hyper-tension). Lancet 1991;338:1281–1285.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Prisant, L.M. (2005). Clinical Trials of Hypertension in the Older Patient. In: Prisant, L.M. (eds) Hypertension in the Elderly. Clinical Hypertension and Vascular Diseases. Humana Press. https://doi.org/10.1007/978-1-59259-911-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-911-0_7

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-197-4

  • Online ISBN: 978-1-59259-911-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics