High blood pressure is a well recognised major risk factor for cardiovascular disease, which is a primary cause of morbidity and mortality in patients aged 70 years or more. A number of studies including STOP-Hypertension-1, SHEP, and MRC II have shown that by lowering blood pressure in the elderly, cardiovascular morbidity and mortality can be significantly reduced.1-3 In fact, treatment of the elderly hypertensive patient is probably more successful than treatment of the young or middle aged patient.

STOP-Hypertension-1 was a double blind trial of 1627 patients aged 70–84 years, which compared placebo with active treatment (one of three β blockers or a fixed ratio combination of hydrochlorothiazide and amiloride). Active treatment for 26 months lowered blood pressure 20/8 mm Hg more than placebo. This resulted in a significant reduction in major cardiovascular events (all strokes, all myocardial infarctions, and other cardiovascular mortality) by 40%, fatal and non-fatal strokes by 47%, and total mortality by 43%.1

The STOP-Hypertension-2 study was designed to investigate how newer antihypertensive treatments (angiotensin converting enzyme (ACE) inhibitors and calcium antagonists) compare with the conventional treatments (β blockers and diuretics) shown to be effective in STOP-Hypertension-1.4 The study examined cardiovascular morbidity and mortality prevention. The primary aim was to assess the effect of the different treatments on mortality. A placebo group was not included for ethical reasons.