Treatment of elderly hypertensives: results and implications of recent trials.

The results of recent trials on the value of antihypertensive treatment are reviewed with special reference to their implications for the elderly. In the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial, there were fewer cardiac deaths on active treatment than in the Australian National Blood Pressure Study (ANBPS) and the Medical Research Council (MRC) trial in which the patients were not elderly and the benefits with treatment were attributable to fewer strokes. An explanation for this difference may be that the combination of hypertension and myocardial infarction is especially lethal in the elderly. In the EWPHE trial there was a significant reduction in nonfatal strokes but not in fatal strokes. The benefits from reducing the incidence of nonfatal stroke in this population merit consideration. As propranolol was less effective than bendrofluazide in lowering blood pressure with increasing age in the MRC trial, and as the incidence of diuretic-induced side effects in the EWPHE trial was high it seems appropriate to study alternate antihypertensive drugs in the elderly.