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BMJ. Feb 15, 1992; 304(6824): 405–412.
PMCID: PMC1995577

Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party.

Abstract

To establish whether treatment with diuretic or beta blocker in hypertensive older adults reduces risk of stroke, coronary heart disease, and death.

Randomised, placebo controlled, single blind trial.

226 general practices in the MRC general practice research framework.

4396 patients aged 65-74 randomised to receive diuretic, beta blocker, or placebo. Patients had mean systolic pressures of 160-209 mm Hg and mean diastolic pressures less than 115 mm Hg during an eight week run in and were not taking antihypertensive treatment.

Patients were randomised to atenolol 50 mg daily; hydrochlorothiazide 25 mg or 50 mg plus amiloride 2.5 mg or 5 mg daily; or placebo. The regimens were adjusted to achieve specified target pressures. Mean follow up was 5.8 years.

Strokes, coronary events, and deaths from all causes.

Both treatments reduced blood pressure below the level in the placebo group. Compared with the placebo group, actively treated subjects (diuretic and beta blocker groups combined) had a 25% (95% confidence interval 3% to 42%) reduction in stroke (p = 0.04), 19% (-2% to 36%) reduction in coronary events (p = 0.08), and 17% (2% to 29%) reduction in all cardiovascular events (p = 0.03). After adjusting for baseline characteristics the diuretic group had significantly reduced risks of stroke (31% (3% to 51%) p = 0.04), coronary events (44% (21% to 60%), p = 0.0009), and all cardiovascular events (35% (17% to 49%), p = 0.0005) compared with the placebo group. The beta blocker group showed no significant reductions in these end points. The reduction in strokes was mainly in non-smokers taking the diuretic.

Hydrochlorothiazide and amiloride reduce the risk of stroke, coronary events, and all cardiovascular events in older hypertensive adults.

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Selected References

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  • Kannel WB, Wolf PA, McGee DL, Dawber TR, McNamara P, Castelli WP. Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham study. JAMA. 1981 Mar 27;245(12):1225–1229. [PubMed]
  • Amery A, Hansson L, Andrén L, Gudbrandsson T, Sivertsson R, Svensson A. Hypertension in the elderly. Hypertension seminars at Ostra Hospital, Göteborg, Sweden. Acta Med Scand. 1981;210(3):221–229. [PubMed]
  • Kuramoto K, Matsushita S, Kuwajima I, Murakami M. Prospective study on the treatment of mild hypertension in the aged. Jpn Heart J. 1981 Jan;22(1):75–85. [PubMed]
  • Sprackling ME, Mitchell JR, Short AH, Watt G. Blood pressure reduction in elderly: a randomised controlled trial of methyldopa. Br Med J (Clin Res Ed) 1981 Oct 31;283(6300):1151–1153. [PMC free article] [PubMed]
  • Carter AB. Hypotensive therapy in stroke survivors. Lancet. 1970 Mar 7;1(7645):485–489. [PubMed]
  • Morgan TO, Adams WR, Hodgson M, Gibberd RW. Failure of therapy to improve prognosis in elderly males with hypertension. Med J Aust. 1980 Jul 12;2(1):27–31. [PubMed]
  • Bird AS, Blizard RA, Mann AH. Treating hypertension in the older person: an evaluation of the association of blood pressure level and its reduction with cognitive performance. J Hypertens. 1990 Feb;8(2):147–152. [PubMed]
  • Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. 1980;58(1):113–130. [PMC free article] [PubMed]
  • Lardinois CK, Neuman SL. The effects of antihypertensive agents on serum lipids and lipoproteins. Arch Intern Med. 1988 Jun;148(6):1280–1288. [PubMed]
  • Sever PS. Antihypertensive and adverse biochemical effects of bendrofluazide: Authors' reply. BMJ. 1990 Jul 07;301(6742):a43–43. [PMC free article]
  • Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, Qizilbash N, Taylor JO, Hennekens CH. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990 Apr 7;335(8693):827–838. [PubMed]
  • Wilhelmsen L, Berglund G, Elmfeldt D, Fitzsimons T, Holzgreve H, Hosie J, Hörnkvist PE, Pennert K, Tuomilehto J, Wedel H. Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial. J Hypertens. 1987 Oct;5(5):561–572. [PubMed]
  • Brown MA, Norris RM, Barnaby PF, Geary GG, Brandt PW. Effect of early treatment with propranolol on left ventricular function four weeks after myocardial infarction. Br Heart J. 1985 Oct;54(4):351–356. [PMC free article] [PubMed]
  • Amery A, Birkenhäger W, Brixko P, Bulpitt C, Clement D, Deruyttere M, De Schaepdryver A, Dollery C, Fagard R, Forette F, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet. 1985 Jun 15;1(8442):1349–1354. [PubMed]
  • Coope J, Warrender TS. Randomised trial of treatment of hypertension in elderly patients in primary care. Br Med J (Clin Res Ed) 1986 Nov 1;293(6555):1145–1151. [PMC free article] [PubMed]
  • Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) Lancet. 1991 Nov 23;338(8778):1281–1285. [PubMed]
  • Pocock SJ, Hughes MD, Lee RJ. Statistical problems in the reporting of clinical trials. A survey of three medical journals. N Engl J Med. 1987 Aug 13;317(7):426–432. [PubMed]
  • Dollery C, Brennan PJ. The Medical Research Council Hypertension Trial: the smoking patient. Am Heart J. 1988 Jan;115(1 Pt 2):276–281. [PubMed]
  • Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet. 1987 Mar 14;1(8533):581–584. [PubMed]
  • Staessen J, Bulpitt C, Clement D, De Leeuw P, Fagard R, Fletcher A, Forette F, Leonetti G, Nissinen A, O'Malley K, et al. Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly. BMJ. 1989 Jun 10;298(6687):1552–1556. [PMC free article] [PubMed]
  • Samuelsson OG, Wilhelmsen LW, Pennert KM, Wedel H, Berglund GL. The J-shaped relationship between coronary heart disease and achieved blood pressure level in treated hypertension: further analyses of 12 years of follow-up of treated hypertensives in the Primary Prevention Trial in Gothenburg, Sweden. J Hypertens. 1990 Jun;8(6):547–555. [PubMed]

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