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The efficacy of new antihypertensive drugs has been questioned. We compared the effects of conventional and newer antihypertensive drugs on cardiovascular mortality and morbidity in elderly patients.

We did a prospective, randomised trial in 6614 patients aged 70–84 years with hypertension (blood pressure ≥180 mm Hg systolic, ≥105 mm Hg diastolic, or both). Patients were randomly assigned conventional antihypertensive drugs (atenolol 50 mg, metoprolol 100 mg, pindolol 5 mg, or hydrochlorothiazide 25 mg plus amiloride 2·5 mg daily) or newer drugs (enalapril 10 mg or lisinopril 10 mg, or felodipine 2·5 mg or isradipine 2–5 mg daily). We assessed fatal stroke, fatal myocardial infarction, and other fatal cardiovascular disease. Analysis was by intention to treat.

Blood pressure was decreased similarly in all treatment groups. The primary combined endpoint of fatal stroke, fatal …