Table 1

Summary of clinical trials demonstrating the value of lowering blood pressure in hypertensive subjects aged 60–79 years

Trial	Entry criteria	n	Age	Treatment	Results/update
ANBP 2, Second Australian National Blood Pressure Study Group^9,¹⁰; EWPHE, European Working Party on High Blood Pressure in the Elderly¹¹; MRC, Medical Research Council trial of treatment of hypertension in older adults¹²; SCOPE, Study on Cognition and Prognosis in the Elderly^13,¹⁴; SHELL, Systolic Hypertension in the Elderly Long-term Lacidipine trial^15,¹⁶; SHEP, Systolic Hypertension in the Elderly Program¹⁷; STOP-Hypertension 2, Swedish Trial in Old Patients with Hypertension^18,¹⁹; Syst-Eur, Systolic Hypertension in Europe^20,²¹; Syst-China, Systolic Hypertension in China.^22,²³
ANBP 2	SBP⩾160 mm Hg	6083	65–84 years	ACE inhibitor or diuretic	Similar reduction in BP in both groups. ACE inhibitor
	DBP⩾90 mm Hg			based regimen	reduced cardiovascular events or death (p = 0.05)
EWPHE	SBP 160–239 mm Hg	840	⩾60 years	Hydrochlorothiazide and	No significant reduction in total mortality. Significant
	DBP 90–119 mm Hg		(mean 72 years)	triamterene with possible addition of	reduction in cardiovascular mortality (p<0.05) and
				methyldopa or matching placebo	non-fatal cerebrovascular events (p<0.05)
MRC	SBP 160–209 mm Hg	4396	65–74 years	Diuretic, β-blocker or placebo	Diuretic reduced stroke (p = 0.04), coronary events
	DBP<115 mm Hg				(p = 0.001) and cardiovascular events (p = 0.001)
					compared with placebo
SCOPE	SBP 160–179 mm Hg	4964	70–89 years	Candesartan, cilexetil or placebo	Candesartan reduced non-fatal stroke (p = 0.04) and
	and/or DBP 90–				all stroke events (p = 0.056). Cognitive decline
	99 mm Hg, Mini				and development of dementia was similar in
	Mental State				both groups
	Examination⩾24
SHELL	SBP⩾160 mm Hg	1882	⩾60 years	Lacidipine or chlorthalidone	Both treatments reduced SBP and DBP (p<0.001).
	DBP⩽95 mm Hg				Total mortality and cardiovascular events were
					similar in both groups
SHEP	SBP 160–219 mm Hg	4736	⩾60 years	Chlorthalidone titrated or	Stroke was reduced (p = 0.001) and major
	DBP<90 mm Hg		(mean 72 years)	changed to atenolol or placebo	cardiovascular events were reduced in the
					active treatment group
STOP-	SBP⩾180 mm Hg	6614	70–84 years	β-Blockers and/or diuretics	No difference was found in the prevention of
Hyperten-	and/or			compared with ACE-inhibitors or	cardiovascular mortality or major events between
sion 2	DBP⩾105 mm Hg			calcium antagonists	the groups
Syst-Eur	DBP<95 mm Hg	4695	⩾60 years	Nitrendipine plus enalapril and/or	Active treatment reduced all strokes (p = 0.003) and
	SBP 160–219 mm Hg		(mean 70 years)	hydrochlorothiazide as necessary	non-fatal strokes (p = 0.007). Fatal and non-fatal
				and matching placebos	cardiac endpoints also decreased (p = 0.03)
Syst-China	SBP 160–219 mm Hg	2394	⩾60 years	Nitrendipine plus captopril,	Active treatment reduced stroke (p = 0.01), stroke
	DBP<95 mm Hg		(mean 66.5 years)	and/or hydrochlorothiazide if	mortality (p = 0.02), all-cause mortality (p = 0.003),
				necessary and matching	cardiovascular mortality (p = 0.03) and all fatal and
				placebos	non-fatal cardiovascular endpoints (p = 0.004)