Treatment of hypertension in the elderly: I. Blood pressure and clinical changes. Results of a department of veterans affairs cooperative study

Barry J. Materson, William C. Cushman, Gerald Goldstein, Domenic J. Reda, Edward D. Freis, Eli A. Ramirez, Frederick N. Talmers, Thomas J. White, Stewart Nunn, Robert H. Chapman, Ibrahim Khatri, Harold Schnaper, J. R. Thomas, William G. Henderson, Carol Fye

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

We compared the efficacy and adverse effects of antihypertensive drug regimens in 690 men past age 60 with diastolic blood pressure 90-114 mm Hg and systolic blood pressure less than 240 mm Hg. They received either a low (25-50 mg) or high (50-100 mg) dose of hydrochlorothiazide daily. Of 644 patients who completed the hydrochlorothiazide titration, 375 (58.2%) were responders (diastolic blood pressure <90 and ≤5 mm Hg below baseline) and 92.8% of these completed a 6-month maintenance period. Blood pressure was reduced from 157.6/98.5 mm Hg by 18.3/9.5 mm Hg with low dose hydrochlorothiazide and by 20.4/9.6 mm Hg with high dose hydrochlorothiazide; more patients achieved goal blood pressure with the high dose. Whites and blacks responded equally. Serum potassium less than 3.5 mmol/l occurred in 104 of 321 (32.3%) of the high dose versus 62 of 333 (18.6%) of the low dose hydrochlorothiazide patients. The 269 nonresponders to hydrochlorothiazide were randomly assigned in a double-blind study to receive hydralazine, methyldopa, metoprolol, or reserpine in addition to hydrochlorothiazide; 79.2% responded to the addition of the second drug and 87.3% of these completed a 6-month maintenance phase. Overall, there were no significant efficacy differences among the step 2 regimens. We conclude that the lower dose of hydrochlorothiazide was nearly as effective as the higher dose, and the addition of a second drug was effective and generally well tolerated in elderly patients.

Original languageEnglish (US)
Pages (from-to)348-360
Number of pages13
JournalHypertension
Volume15
Issue number4
DOIs
StatePublished - Apr 1990

Keywords

  • Aging
  • Essential hypertension
  • Hydralazine
  • Hydrochlorothiazide
  • Methyldopa
  • Metoprolol
  • Reserpme

ASJC Scopus subject areas

  • Internal Medicine

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    Materson, B. J., Cushman, W. C., Goldstein, G., Reda, D. J., Freis, E. D., Ramirez, E. A., Talmers, F. N., White, T. J., Nunn, S., Chapman, R. H., Khatri, I., Schnaper, H., Thomas, J. R., Henderson, W. G., & Fye, C. (1990). Treatment of hypertension in the elderly: I. Blood pressure and clinical changes. Results of a department of veterans affairs cooperative study. Hypertension, 15(4), 348-360. https://doi.org/10.1161/01.HYP.15.4.348