No abstract

Antihypertensive treatment prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension. Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes or 59 major cardiovascular endpoints.

We assessed, in a double-blind, placebo-controlled trial, whether lowering blood pressure (BP) prevents the recurrence of stroke in Chinese patients with cerebrovascular disease. Patients were randomized into two groups: 2825 patients received a placebo and 2840 patients received 2.5 mg of indapamide daily. The primary and secondary outcomes were the recurrence of fatal or nonfatal stroke and major fatal and nonfatal cardiovascular events, respectively. The average systolic/diastolic BP at randomization was 153.8/92.8 mm Hg. At median follow-up (2 years), BP was, on an average, 6.8/3.3 mm Hg lower in patients on active treatment. In total, 143 patients on indapamide and 219 patients on placebo had recurrent strokes (hazard ratio for indapamide, 0.69; 95% confidence interval (CI): 0.54-0.89; Po0.001). In addition, 199 patients on indapamide and 258 patients on placebo had a cardiovascular event (hazard ratio, 0.75; 95% CI: 0.89-0.62; P¼0.002). We performed a systematic review of literature that included our new results. Across 10 trials, the odds ratio for the prevention of stroke recurrence by BP lowering was 0.78 (95% CI: 0.68-0.90; P¼0.0007). The pooled odds ratio was 0.63 (95% CI: 0.54-0.73; Po0.0001) for trials involving diuretics as a component of therapy and 0.93 (95% CI: 0.87-1.01; P¼0.086) for trials in which treatment included renin system inhibitors (Po0.0001 for heterogeneity). The weighted correlation between the odds for stroke recurrence and the reduction in systolic BP was À0.57 (P¼0.067). In conclusion, BP lowering by indapamide treatment reduced the recurrence of stroke and the incidence of cardiovascular events in Chinese patients with cerebrovascular disease. Whether prevention of stroke recurrence depends on drug class, degree of BP lowering or both requires further investigation.

Abstract-We examined the relation of serum creatinine and uric acid to mortality and cardiovascular disease in older (aged Ն60 years) Chinese patients with isolated systolic hypertension (systolic/diastolic blood pressure Ն160/ Ͻ95 mm Hg). We used Cox regression to correlate outcome with baseline serum creatinine and uric acid measured in 1880 and 1873, respectively, of the 2394 patients enrolled in the placebo-controlled Systolic Hypertension in China (Syst-China) Trial. Median follow-up was 3 years. In multiple Cox regression analysis with adjustment for gender, age, active treatment, and other significant covariates, serum creatinine was significantly associated with a worse prognosis. The relative hazard rates (95% CIs) associated with a 20-mol/L increase in serum creatinine for all-cause, cardiovascular, and stroke mortality were 1.16 (1.05 to 1.27, Pϭ0.003), 1.15 (1.01 to 1.31, Pϭ0.03), and 1.37 (1.13 to 1.65, Pϭ0.001), respectively. In a similar analysis, which also accounted for serum creatinine, serum uric acid was also significantly and independently associated with excess mortality of cardiovascular disease and stroke. The relative hazard rates associated with a 50-mol/L increase of serum uric acid were 1.14 (1.02 to 1.27, Pϭ0.02) for cardiovascular mortality and 1.34 (1.14 to 1.57, PϽ0.001) for fatal stroke. In conclusion, in older Chinese patients with isolated systolic hypertension, serum creatinine and serum uric acid were predictors of mortality. (Hypertension. 2001; 37:1069-1074.)