The newer anti hypertensive drugs, such as the ACE inhibitor, do not produce significantly better results than older style heart drugs, especially in the elderly, according to new research.

The Stop 2 trial concluded that among hypertensive people aged 70 to 84 the reduction in blood pressure and the risk of a major cardiovascular events were the

same, whether patients were given conventional therapy (defined as a hydrochlorothiazide/

amiloride combination and/or one of three beta blockers) or a newer therapy such as a calcium channel blocker (in this case felodipine) or an ACE inhibitor (enalapril or lisinopril).

The trial was large 6614 patients and was conducted over a reasonably long period of time. Apart from the main conclusions, some other interesting things came out of the trial such fact that nearly half of all the patients in the study were taking more than one drug. By the time of their last visit, only two thirds of the patients were still taking the same medications they were taking at the beginning of the trial.

Being overmedicated or switched between medications, often without a rational reason, continues to be a problem for

elderly patients. It was also a problem for the researchers, too making it difficult to ascertain the true impact of the drugs studied.

Across all three drug groups, side effects were common. More than a quarter of patients in all three groups suffered dizziness, and ACE inhibitors produced a dry cough in a third of patients (Lancet, 1999; 354: 175 -6).

l Another smaller trial has also added to the debate about heart medicines. The ELITE-2 trial, which was designed to show the superiority of sartans (losartan) over ACE inhibitors (captopril) found that there was not much difference between them. Although the patients in the ACE inhibitor group had a slightly lower mortality rate and a lower prevalence of sudden death, the difference between the two types of drug did not really reach significance (Lancet, 1999; 354: 1797).

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