Effect of two different therapeutic approaches on total and cardiovascular mortality in a Cardiovascular Study in the Elderly (CASTEL).
Although limited numbers of elderly subjects have occasionally been included in population-based studies, only a few studies have been conducted specifically on elderly hypertensives, and practically none at a population level. We studied 655 hypertensive subjects from a cohort of 2,254 elderly subjects. The intervention consisted of the creation of a Hypertension Outpatients' Clinic under our auspices but with complete co-operation from general practitioners, randomizing the identified hypertensive patients into pre-established therapeutic drug regimens, and early follow-up recording of mortality for 7 years. The drugs used were clonidine (n = 61), nifedipine (n = 146) and the fixed combination of atenolol+chlorthalidone (n = 144); 304 subjects underwent "free therapy" by their personal physicians without any special intervention. There were 1,404 normotensive subjects. Overall 7-year follow-up mortality was 34.9% in the hypertensive subjects receiving "free therapy", 22.5% in those receiving "special care", and 24.2% in the normotensives. Cardiovascular mortality was respectively 23.7%, 12.2%, and 12.0%. Overall and cardiovascular annual cumulative mortality were significantly lower in the << special therapy >> than in the << free therapy >> group. The fixed combination of atenolol and chlorthalidone reduced mortality below that of the normotensives, independent of other cardiovascular risk factors.
Casiglia
E
E
Institute of Clinical Medicine, University of Padova, Italy.
Spolaore
P
P
Mazza
A
A
Ginocchio
G
G
Colangeli
G
G
Onesto
C
C
Di Menza
G
G
Pegoraro
L
L
Ambrosio
G B
GB
D000368:Aged; D000369:Aged, 80 and over; D001262:Atenolol / Q000008:administration & dosage; D002752:Chlorthalidone / Q000008:administration & dosage; D003000:Clonidine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D008297:Male; D009543:Nifedipine / Q000627:therapeutic use; D011446:Prospective Studies; D016019:Survival Analysis
D001262:Atenolol; D009543:Nifedipine; D003000:Clonidine; D002752:Chlorthalidone