Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

被引:30
作者
Ogihara, Toshio [2 ,4 ]
Matsuzaki, Masunori [3 ]
Umemoto, Seiji [1 ]
Rakugi, Hiromi [2 ]
Matsuoka, Hiroaki [5 ]
Shimada, Kazuyuki [6 ]
Higaki, Jitsuo [7 ]
Ito, Sadayoshi [8 ]
Kamiya, Akira [1 ]
Suzuki, Hiromichi [9 ]
Ohashi, Yasuo [10 ]
Shimamoto, Kazuaki [11 ]
Saruta, Takao [12 ]
机构
[1] Yamaguchi Univ, Pharmaceut Clin Res Ctr, Ube, Yamaguchi 7558505, Japan
[2] Osaka Univ, Grad Sch Med, Dept Geriatr Med & Nephrol, Suita, Osaka, Japan
[3] Yamaguchi Univ, Grad Sch Med, Dept Med & Clin Sci, Ube, Yamaguchi 755, Japan
[4] Morinomiya Univ Med Sci, Osaka, Japan
[5] Dokkyo Med Univ, Dept Hypertens & Cardiorenal Med, Mibu, Tochigi, Japan
[6] Jichi Med Univ, Sch Med, Dept Med, Div Cardiovasc Med, Shimotsuke, Japan
[7] Ehime Univ, Grad Sch Med, Dept Integrated Med & Informat, Div Cardiol, Toon, Japan
[8] Tohoku Univ, Sch Med, Dept Med, Div Nephrol Endocrinol & Vasc Med, Sendai, Miyagi 980, Japan
[9] Saitama Med Univ, Sch Med, Dept Nephrol, Iruma, Saitama, Japan
[10] Univ Tokyo, Sch Publ Hlth, Dept Biostat, Tokyo, Japan
[11] Sapporo Med Univ, Sch Med, Sapporo, Hokkaido, Japan
[12] Keio Univ, Tokyo, Japan
关键词
angiotensin-receptor blocker; beta-blocker; calcium-channel blocker; elderly; thiazide diuretic; BLOOD-PRESSURE; MORTALITY; STROKE; AGE; METAANALYSIS; GUIDELINES; MANAGEMENT; MORBIDITY; REGIMENS; OUTCOMES;
D O I
10.1038/hr.2011.216
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
The Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) trial demonstrated that the calcium-channel blocker benidipine-based combination therapies with an angiotensin-receptor blocker (ARB), a beta-blocker, or a thiazide diuretic (thiazide) were similarly effective in preventing cardiovascular events and achieving the target blood pressure (BP; <140/90 mm Hg). We further evaluated the efficacy and safety of these combination therapies in older (>= 65 years) and younger (<65 years) hypertensive patients. In this sub-analysis of the COPE trial 3293 patients (1533 >= 65 years old and 1760 <65 years old) were randomly assigned to receive benidipine-based therapy with an ARB, a beta-blocker or a thiazide. In each group, the average BP did not differ among the three treatment groups. The incidence of the primary cardiovascular composite end point in the older group was higher than in the younger group (12.7 vs. 8.3 per 1000 person-years, P=0.023). The primary composite cardiovascular end point, achievement (%) of target BP, and cardiovascular hard composite end points were similar among the three treatment groups. However, the hazard ratios and 95% confidence intervals in older patients were 2.74 (1.08-6.96; beta-blocker vs. thiazide, P=0.022) for fatal and non-fatal stroke, and 2.47 (1.03-5.91; beta-blocker vs. ARB, P=0.043) for new-onset diabetes. Thus, benidipine combined with an ARB, a beta-blocker, or a thiazide was similarly effective in preventing cardiovascular events and achieving the target BP in both older and younger hypertensive patients. Further studies will be necessary to evaluate the usefulness of benidipine combined with a beta-blocker in terms of the incidence of stroke and new-onset diabetes in older patients. Hypertension Research (2012) 35, 441-448; doi: 10.1038/hr.2011.216; published online 26 January 2012
引用
收藏
页码:441 / 448
页数:8
相关论文
共 30 条
[1]   VERAPAMIL PHARMACODYNAMICS AND DISPOSITION IN YOUNG AND ELDERLY HYPERTENSIVE PATIENTS - ALTERED ELECTROCARDIOGRAPHIC AND HYPOTENSIVE RESPONSES [J].
ABERNETHY, DR ;
SCHWARTZ, JB ;
TODD, EL ;
LUCHI, R ;
SNOW, E .
ANNALS OF INTERNAL MEDICINE, 1986, 105 (03) :329-336
[2]  
AMERY A, 1985, LANCET, V1, P1349
[3]  
[Anonymous], 1991, JAMA, V265, P3255
[4]  
Antihypertensive T., 2002, JAMA-J AM MED ASSOC, V288, P2981, DOI [10.1001/jama.288.23.2981, DOI 10.1001/JAMA.288.23.2981]
[5]  
Bakris George L., 1999, J Clin Hypertens (Greenwich), V1, P141
[6]   Treatment of hypertension in patients 80 years of age or older [J].
Beckett, Nigel S. ;
Peters, Ruth ;
Fletcher, Astrid E. ;
Staessen, Jan A. ;
Liu, Lisheng ;
Dumitrascu, Dan ;
Stoyanovsky, Vassil ;
Antikainen, Riitta L. ;
Nikitin, Yuri ;
Anderson, Craig ;
Belhani, Alli ;
Forette, Francoise ;
Rajkumar, Chakravarthi ;
Thijs, Lutgarde ;
Banya, Winston ;
Bulpitt, Christopher J. .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (18) :1887-1898
[7]   Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [J].
Chobanian, AV ;
Bakris, GL ;
Black, HR ;
Cushman, WC ;
Green, LA ;
Izzo, JL ;
Jones, DW ;
Materson, BJ ;
Oparil, S ;
Wright, JT ;
Roccella, EJ .
HYPERTENSION, 2003, 42 (06) :1206-1252
[8]   Impact of amlodipine-based therapy among older and younger patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) [J].
Collier, David J. ;
Poulter, Neil R. ;
Dahlof, Bjorn ;
Sever, Peter S. ;
Wedel, Hans ;
Buch, Jan ;
Caulfield, Mark J. .
JOURNAL OF HYPERTENSION, 2011, 29 (03) :583-591
[9]   MORBIDITY AND MORTALITY IN THE SWEDISH TRIAL IN OLD PATIENTS WITH HYPERTENSION (STOP-HYPERTENSION) [J].
DAHLOF, B ;
LINDHOLM, LH ;
HANSSON, L ;
SCHERSTEN, B ;
EKBOM, T ;
WESTER, PO .
LANCET, 1991, 338 (8778) :1281-1285
[10]  
Franklin SS, 1997, CIRCULATION, V96, P308