Antihypertensive therapy debate: contribution from the Shanghai Trial Of Nifedipine in the Elderly (STONE)

Abstract

Background In 1993, a number of influential bodies reported the results of consensus conferences on the management of hypertension, including the World Health Organization/ International Society of Hypertension, the fifth United States Joint National Committee (JNC-V), the British Hypertension Society, the Canadian Hypertension Society (CHS) and the New Zealand National Advisory Committee. Most of these guidelines were in general agreement. The most significant difference was in the choice of first-line agents, whether to use only p-blockers or thiazides (JNC-V/CHS) or to use any of the five major classes of antihypertensive agents.

Evidence from the Shanghai Trial Of Nifedipine in the Elderly (STONE) At present, this is the only placebo-controlled trial on newer classes of medications for which results are available. The trial has both strengths and weaknesses. Among the strengths of this trial is the comparability of the subjects in both arms and the robustness of the results. STONE does at least suggest that outcomes with newer agents like long-acting nifedipine are comparable to outcomes in major clinical trials in the elderly using diuretics and αblockers.