@article{941b121079be408595620d853ca1ee00,
title = "Southwestern Internal Medicine Conference: The promises and perils of treating the elderly hypertensive",
abstract = "Recently published clinical trials have shown clear benefits of the treatment of hypertension in the elderly. Therefore, millions of elderly patients will be considered in need of antihypertensive therapy. In addition to the promises that such therapy offer, there are multiple perils involved in the treatment of elderly patients.",
author = "Kaplan, {Norman M}",
note = "Funding Information: cardiovascular events and deaths in the diuretic group than in the beta-blocker group (Figures 4 and 5). Reduction in stroke events was confined to nonsmokers, but coronary events and all-cause mortality did not differ between smokers and nonsmokers. However, the effect of the beta-blocker on all-cause mortality was significantly reduced by smoking, compared to the effect of the diuretic. The most striking finding of this trial is that diuretics prevented coronary events and deaths, whereas the beta-blocker gave no protective effect against any end point and was associated with an increased mortality from cancer. The authors offer a number of possibilities for {"}this interesting finding (that) is contrary to expectations.{"} These include only a small (0.1 mmolfl) increase in serum cholesterol; the lower dose of diuretic and concomitant use of a potassium-sparing agent; the more rapid and greater control of blood pressure with the diuretic; and differences in the nature ofhypertension and responses to treatment in the elderly compared to younger patients. The high rates of dropout and withdrawal, although likely inherent in the nature of this study design, are of concern. Similarly, the high rate of addition of various drugs to achieve the goals of therapy make the data somewhat difficult to interpret. Nonetheless, the striking differences between the diuretic and beta-blocker groups appear to be significant, statistically and clinically. This is the conclusion reached by the six British hypertension experts whose analysis of the six published randomized trials of the treatment of hypertension in elderly patients follows the report of the Medical Research Council trial. 84 After delineating the differences",
year = "1993",
doi = "10.1097/00000441-199303000-00011",
language = "English (US)",
volume = "305",
pages = "183--197",
journal = "American Journal of the Medical Sciences",
issn = "0002-9629",
publisher = "Lippincott Williams and Wilkins",
number = "3",
}