Antihypertensive Therapy in Patients above Age 60 Years (Fourth Interim Report of the European Working Party on High Blood Pressure in Elderly: EWPHE)

Abstract

1. A total of 450 hypertensive patients above the age of 60 years have entered the double-blind multicentre trial of the European Working Party on High blood pressure in Elderly (EWPHE). After stratification and randomization half were treated with one capsule daily containing 25 mg of hydrochlorothiazide and 50 mg of triamterene and half were given placebo. In those receiving active treatment, if blood pressure control was not adequate they were given a second capsule and if necessary up to 2 g of methyldopa/day. 2. No significant differences between the groups were present before randomization. A significant blood pressure difference of 25/10 mmHg was obtained between the groups and maintained during 4 years of follow-up. No major disturbances in serum potassium or serum sodium were noted with the present drug combination. 3. During the initial phase an increase in serum creatinine and serum uric acid was noted in the actively treated group, which was maintained during the later years. This increase in serum creatinine in the actively treated group was related (P = 0·003 and r = −0·247) to the decrease in sitting systolic blood pressure. Changes in serum uric acid were (r = 0·3 and P = 0·003) correlated with the changes in serum creatinine both in the placebo and in the actively treated group, but independent of the change in creatinine; the serum uric acid was on average 1 mg higher in the actively treated than in the placebo group. 4. Fasting blood glucose did not change significantly in the placebo-treated group but in the active treatment group the rise was statistically significant. 5. A favourable influence on prognosis by active treatment can be expected on the basis of the blood pressure reduction and in the absence of major electrolytes disturbances. However, the balance between this decreased risk and the increased risk produced by the rise in blood glucose and the other treatment effects remains to be determined. Therefore the trial continues and more patients are being admitted.

Follow-up of renal function in treated and untreated older patients with isolated systolic hypertension

“…In the double-blind placebo-controlled trial conducted by the European Working Party on High Blood Pressure in the Elderly [2,8,30], the patients of the activetreatment group received hydrochlorothiazide plus triamterene, to which, in 35% of the patients, ámethyldopa was added [2,8,30]. During follow-up, serum creatinine concentration increased in both treatment groups, but the increase was already more pronounced in the actively treated group after 3 months (15.9 ìmol/l; compared with 1.8 ìmol/l; P , 0.001) [2,8,30]. With incidence rates of 33.3 and 9.8 events per 1000 patient-years, the risk of mild renal dysfunction (serum creatinine concentration at least 180 ìmol/l) was 23% greater (CI 12±35%) in actively treated patients [8].…”

Effect of nicardipine in elderly hypertensive patients.

“…At present, diuretics are generally used as first-line treatment (Amery et al, 1978), and their safety is satisfactory when adequate clinical and laboratory monitoring are done at regular intervals (Forette et al, 1982b). However, such monitoring is constraining to the patient and may lead to inadequate compliance, which in turn can give rise to serious complications (Editorial, 1978).…”

Are the effects of blood pressure lowering treatment diminishing?: meta-regression analyses

“…In BBB [ 16 ], we could not extract all-cause mortality data because it was not indicated in the paper. In EWPHE [ 17 ], we used the number from the intention-to-treat analysis. Regarding stroke, there were five differences compared with the Ettehad paper (Supp.…”

“…In JATOS [ 20 ], we subtracted the number of TIA. In EWPHE [ 17 ], we used the numbers from the intention-to-treat analysis. In the Hunan Province study [ 21 ], we used the data indicated in the original publication.…”