Swedish Trial in Old Patients with Hypertension - STOP-HTN

Description:

Pharmacologic treatment vs placebo in elderly hypertensive patients

Hypothesis:

To demonstrate the efficacy of pharmological treatment of hypertension in patients 70-84 years old.

Study Design

Study Design:

Patients Screened: Not reported
Patients Enrolled: 1627
NYHA Class: Not reported
Mean Follow Up: 1-4 years (average 25 months)
Mean Patient Age: 70-84 years (mean 76)
Female: 63%
Mean Ejection Fraction: Not evaluated

Patient Populations:

70–84 years of age and with SBP 180–230 mm Hg and DBP ≥ 90 mm Hg (or DBP 105–120 mm Hg).

Exclusions:

MI or stroke within prior 12 months, isolated systolic hypertension (SBP >180 mm Hg and DBP <90 mm Hg), orthostatic hypotension, BP >230/120 mmHg

Primary Endpoints:

Stroke, MI, and other cardiovascular death

Drug/Procedures Used:

Atenolol (50 mg once daily), hydrochlorothiazide (HCTZ) (25 mg once daily) plus amiloride (2.5 mg once daily), metoprolol (100 mg once daily), pindolol (5 mg once daily), or placebo. Of note, the centers were free to choose any of the 4 regimens. If BP was >160/95 mmHg after 2 months of treatment, a second agent was added. If BP was >230/120 mmHg on 2 subsequent visits, open antihypertensive tratement was initiated.

Principal Findings:

The pharmacologically treated patients had a significant 40% relative risk reduction (RRR) in the incidence of the composite primary endpoint(3.35%/yr vs. 5.55%/yr, p = 0.0031), 47% RRR in strokes (1.68%/yr vs. 3.13%/yr), 13% RRR in all MIs (1.44%/yr vs. 1.65%/yr), 70% RRR in other cardiovascular deaths (0. 25%/yr vs. 0.77%/yr), 50% RRR in vascular mortality (0.17%/yr vs. 0.34%/yr), and 43% RRR in total mortality (2.02%/yr vs. 3.54%/yr, p = 0.0079). Of note, a majority of patients required combined treatment to attain the blood pressure goal o(160/95 mmHg) [see Clin Exper Hypertension 1993;15:925-39).

Interpretation:

Pharmacologic therapy in hypertensive patients aged 70-84 years decreased cardiovascular mortality and morbidity.

References:

Lancet 1991;338:1281–1285. Related trials: STOP-HTN 2 (Lancet 1999;354:1751-56)

Clinical Topics: Prevention, Statins, Hypertension

Keywords: Risk, Stroke, Morbidity, Diuretics, Pindolol, Hydrochlorothiazide, Metoprolol, Hypertension


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