HYPOTENSIVE THERAPY IN STROKE SURVIVORS

In this series significant improvement occurred in treated hypertensive patients who had survived a stroke if they were aged 65 or below, but not if they was older, and in patients aged over 65 treatment of systolic hypertension was of no benefit, although the diastolic hypertensives improved marginally with treatment.

Abstract

A prospective randomised controlled trial of hypotensive therapy in 97 hypertensive patients surviving an ischæmic-type stroke was started in 1964 and terminated 4 years later. The patients were under 80 years of age, consecutively admitted to one hospital and the control and treated groups compared well for age, sex, and severity of hypertension. The drugs used were methyldopa, bethanidine or debrisoquine combined with restriction of salt intake, weight reduction, and thiazide diuretics, and the results were analysed with regard to survival and recurrence rates. Hypertension was defined as diastolic if this pressure was 110 mm. Hg or above, and as systolic if this pressure was over 160 mm. Hg with the diastolic below 110 mm. Hg. The mortality-rate at the end of a 2 to 5 year followup was 26% in the treated group and 46% in the untreated, and the non-fatal recurrence-rate 14% in the treated and 23% in the controls. Good smooth control was essential to success, untreated patients doing better than those whose control was unsatisfactory. In patients aged over 65 treatment of systolic hypertension was of no benefit, although the diastolic hypertensives improved marginally with treatment. As age increased this effect was progressively less apparent but the figures are probably too small to mean anything. In this series significant improvement occurred in treated hypertensive patients who had survived a stroke if they were aged 65 or below, but not if they were older.