Table 1

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

TrialEntry criterianAgeTreatmentResults/update
ANBP 2, Second Australian National Blood Pressure Study Group9,10; 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 Elderly13,14; SHELL, Systolic Hypertension in the Elderly Long-term Lacidipine trial15,16; SHEP, Systolic Hypertension in the Elderly Program17; STOP-Hypertension 2, Swedish Trial in Old Patients with Hypertension18,19; Syst-Eur, Systolic Hypertension in Europe20,21; Syst-China, Systolic Hypertension in China.22,23
ANBP 2SBP⩾160 mm Hg608365–84 yearsACE inhibitor or diureticSimilar reduction in BP in both groups. ACE inhibitor
DBP⩾90 mm Hgbased regimenreduced cardiovascular events or death (p = 0.05)
EWPHESBP 160–239 mm Hg840⩾60 yearsHydrochlorothiazide andNo significant reduction in total mortality. Significant
DBP 90–119 mm Hg(mean 72 years)triamterene with possible addition ofreduction in cardiovascular mortality (p<0.05) and
methyldopa or matching placebonon-fatal cerebrovascular events (p<0.05)
MRCSBP 160–209 mm Hg439665–74 yearsDiuretic, β-blocker or placeboDiuretic reduced stroke (p = 0.04), coronary events
DBP<115 mm Hg(p = 0.001) and cardiovascular events (p = 0.001)
compared with placebo
SCOPESBP 160–179 mm Hg496470–89 yearsCandesartan, cilexetil or placeboCandesartan reduced non-fatal stroke (p = 0.04) and
and/or DBP 90–all stroke events (p = 0.056). Cognitive decline
99 mm Hg, Miniand development of dementia was similar in
Mental Stateboth groups
SHELLSBP⩾160 mm Hg1882⩾60 yearsLacidipine or chlorthalidoneBoth treatments reduced SBP and DBP (p<0.001).
DBP⩽95 mm HgTotal mortality and cardiovascular events were
similar in both groups
SHEPSBP 160–219 mm Hg4736⩾60 yearsChlorthalidone titrated orStroke was reduced (p = 0.001) and major
DBP<90 mm Hg(mean 72 years)changed to atenolol or placebocardiovascular events were reduced in the
active treatment group
STOP-SBP⩾180 mm Hg661470–84 yearsβ-Blockers and/or diureticsNo difference was found in the prevention of
Hyperten-and/orcompared with ACE-inhibitors orcardiovascular mortality or major events between
sion 2DBP⩾105 mm Hgcalcium antagoniststhe groups
Syst-EurDBP<95 mm Hg4695⩾60 yearsNitrendipine plus enalapril and/orActive treatment reduced all strokes (p = 0.003) and
SBP 160–219 mm Hg(mean 70 years)hydrochlorothiazide as necessarynon-fatal strokes (p = 0.007). Fatal and non-fatal
and matching placeboscardiac endpoints also decreased (p = 0.03)
Syst-ChinaSBP 160–219 mm Hg2394⩾60 yearsNitrendipine plus captopril,Active treatment reduced stroke (p = 0.01), stroke
DBP<95 mm Hg(mean 66.5 years)and/or hydrochlorothiazide ifmortality (p = 0.02), all-cause mortality (p = 0.003),
necessary and matchingcardiovascular mortality (p = 0.03) and all fatal and
placebosnon-fatal cardiovascular endpoints (p = 0.004)