Future goals for the treatment of hypertension in the elderly with reference to STOP-Hypertension, SHEP, and the MRC trial in older adults.

During 1991 and 1992, three major interventional trials were published that dealt with the value of antihypertensive treatment in the elderly. The three studies were the American Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension), and the British Medical Research Council (MRC) Trial of Treatment of Hypertension in Older Adults. The three trials all compared active antihypertensive treatment, mainly diuretics or beta-adrenoceptor blocking agents, or the two in combination, with placebo. Two of the trials were double-blind (SHEP and STOP) whereas the MRC trial was single-blind. All three were multicentered, prospective, and included randomization. One of the trials (SHEP) was specifically designed to evaluate antihypertensive treatment in patients with isolated systolic hypertension. The SHEP, STOP, and MRC trials all showed that treatment of hypertension in the elderly reduces the risk of stroke and cardiovascular events. In one of the trials, total mortality was also positively affected. Thus, in the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. On the basis of these trials, it is apparent that antihypertensive treatment with low-dose thiazides or beta-blockers, or the two in combination, can produce highly beneficial results in elderly patients, including a reduction in the incidence of stroke and other cardiovascular events as well as in total mortality. Furthermore, special analyses indicate that the cost:benefit aspects of such treatment is at least as positive as in young and middle-aged hypertensive patients.