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Swedish Trial in Old Patients with Hypertension-2 - STOP-HTN 2
Description:
Beta blockers and diuretics versus calcium channel blockers and ACE inhibitors in hypertension
Hypothesis:
To compare the effectiveness of beta-blockers and diuretics to calcium channel blocker and ACE inhibitors on cardiovascular mortality in elderly hypertensive patients
Study Design
Study Design:
Patients Screened: Not reported
Patients Enrolled: 6614
NYHA Class: Not reported
Mean Follow Up: 54 months
Mean Patient Age: 70-84 years (average 76)
Female: 33%
Mean Ejection Fraction: Not evaluated
Patient Populations:
Aged 70-84 years with SBP 180mmHg or greater, DBP 105 mmHg or greater, or both
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:
Fatal stroke + fatal MI + other fatal cardiovascular disease
Secondary Endpoints:
All-cause mortality, cardiovascular mortality, all strokes + all MIs + other CV mortality
Drug/Procedures Used:
Conventional treatment (beta-blockers [atenolol 50 mg/day, metoprolol 100 mg/day, pindolol 5 mg/day], diuretics [hydrochlorothiazide 25 mg plus amiloride 2.5 mg/day]), calcium channel blockers (felodipine 2.5 mg/day or isradipine 2.5 mg/day), or ACE inhibitors (enalapril 10 mg/day or lisinopril 10 mg/day). If target BP not achived, diuretics added to patients on beta-blockers or ACE inhibitors and beat-blockers to those on diuretics or calcium channel blockers
Principal Findings:
Blood pressure was reduced similarly in all groups. The incidence of the primary combined endpoint of fatal stroke, fatal MI, and other fatal cardiovascular disease occurred was 1.98%/patient year in both the conventional and newer drug groups. Total mortality was 3.31%/pt year with conventional therapy, 3.44%/pt year with ACE inhibitors, and 3.28%/pt year with calcium antagonists. There was also no significant difference between the conventional and newer drugs groups in the incidenc of the combined secondary endpoint of fatal and nonfatal stroke, fatal and nonfatal MI, and other cardiovascular mortality (relative risk 0.96, p=0.49). The incidence of congestive heart failure and acute MI was significantly lower in ACE inhibitor group versus calcium antagonist group (RR 0.78, 95% CI 0.63-0.97, p=0.025; RR 0.77, 95% CI 0.61-0.96, p=0.018). No other secondary endpoints of cardiovascular mortality and morbidity had statistically significant differences between the three treatment groups.
Interpretation:
Old and new classes of antihypertensive drugs were similar in the prevetnion of cardiovascular mortality or major events. Reduction in blood pressure was strongly associated with a reduction in cardiovascular events.
References:
1. Lancet 1999;354:1751-6.
Keywords: Risk, Felodipine, Enalapril, Stroke, Diuretics, Calcium Channel Blockers, Pindolol, Lisinopril, Isradipine, Heart Failure, Hydrochlorothiazide, Metoprolol, Hypertension
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