Treatment of hypertension in the elderly

✍ Scribed by W. H. Birkenhäger; P. W. Leeuw; A. Amery; J. Staessen

• Publisher: Springer US
• Year: 1988
• Tongue: English
• Weight: 408 KB
• Volume: 2
• Category: Article
• ISSN: 0920-3206
• DOI: 10.1007/bf00054632

✦ Synopsis

Veterans' Administration Co-operative Group

W hen the causes of chronic morbidity and disability in people beyond middle age are analyzed it is obvious that cerebrovascular and cardiac ailments are the main contributors. Among the quantifiable risk factors for these disorders in older people high blood pressure tends to rank higher than any other variable [1]. The dilemma of whether to treat or not to treat appears to have been solved by a series of empirical data. Our editorial comment first reviews controlled therapeutic trials in older patients with mild and moderate hypertension.

In one of the reports by the pioneering Veterans Administration Cooperative Group [2], all available events, fatal and nonfatal combined, were described in patients aged 60 years and above. Active treatment was composed of hydrochlorothiazide, reserpine, and hydralazine in different combinations. In the actively treated patients, a 54% (p < 0.003) reduction in all cardiovascular events, as compared to those on placebo, was noticed. The decrease was mainly due to a reduction in left ventricular failure, nine cases having been observed in the placebo and none in the active treatment group (-100%; p < 0.003). The incidence of cerebrovascular accidents was impressive (-66%) although this decline failed to attain statistical significance, due to the small number of subjects in this subgroup (Table 1). The standard criticism of this trial is, that the study population was rather dissimilar from the average population, from a demographic point of view. It consisted of ex-servicemen, many of them in a chronic state of ill-health due to the additional presence of other risk factors.