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Overview of the outcome trials in older patients with isolated systolic hypertension

J A Staessen1, J G Wang, L Thijs

  • 1Hypertensie en Cardiovasculaire Revalidatie Eenheid, Departement voor Moleculair en Cardiovasculair Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium.

Journal of Human Hypertension
|January 5, 2000
PubMed

Insights

Antihypertensive drug treatment significantly reduces cardiovascular events and mortality in older adults with isolated systolic hypertension (ISH). These findings support prescribing medication for ISH when systolic blood pressure is 160 mm Hg or higher.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Isolated systolic hypertension (ISH) is prevalent in individuals over 60, representing a major modifiable cardiovascular risk factor.
  • Three key placebo-controlled outcome trials have investigated antihypertensive drug treatment for ISH in the elderly.

Purpose of the Study:

  • To review three major outcome trials on antihypertensive drug treatment for ISH in the elderly.
  • To present pooled estimates of the benefits of such treatment.

Main Methods:

  • The Systolic Hypertension in the Elderly Program (SHEP), Systolic Hypertension in Europe (Syst-Eur), and Systolic Hypertension in China (Syst-China) trials were analyzed.
  • Pooled odds ratios were calculated for active versus placebo treatment across five major endpoints.
  • Zelen's exact test for homogeneity confirmed a common treatment effect across trials.

Main Results:

  • Active antihypertensive treatment significantly reduced all-cause mortality by 17% and cardiovascular mortality by 25%.
  • Treatment led to a 32% reduction in all cardiovascular endpoints, 37% in total stroke, and 25% in myocardial infarction including sudden death.
  • No statistical significance was reached for homogeneity, supporting a consistent treatment effect.

Conclusions:

  • Pooled results from outcome trials demonstrate the efficacy of antihypertensive drug treatment in older patients with ISH.
  • Antihypertensive drug treatment is recommended for isolated systolic hypertension when systolic blood pressure is persistently 160 mm Hg or higher.
Abstract

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