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

Staessen, Jan A.; Wang, J G; Thijs, Lutgarde; Fagard, Robert

doi:10.1038/sj.jhh.1000899

Cited by 48 publications

(18 citation statements)

References 22 publications

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“…4 BP reduction has been shown to be effective in lowering stroke risk in both primary and secondary prevention. [25][26][27] In our study, the estimated risk of stroke at 10 years was lower in patients with elevated BP without diagnosis of HT than in patients with HT previously diagnosed despite slightly higher BP values in the patients without a diagnosis of HT. On stratifying by BP levels according to the classification of the Seventh Report of the Joint National Committee, 10 estimated risk was seen to be greater among the patients with a In the multiple linear regression model, patient age, atrial fibrillation, and LVH were factors of considerable impact on risk estimation in this population in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 62%

Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain

Redón

Cea‐Calvo²,

Lozano³

et al. 2007

Stroke

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on behalf of the investigators of the PREV-ICTUS study Background and Purpose-The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. Methods-This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. Results-We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic-left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; PϽ0.001). Conclusion-The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

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Section: Discussionmentioning

confidence: 62%

Blood Pressure and Estimated Risk of Stroke in the Elderly Population of Spain

Redón

Cea‐Calvo²,

Lozano³

et al. 2007

Stroke

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“…This explanation of our finding is consistent with previous reports indicating that doctors were not inclined to treat elderly people with stage 1 hypertension or with stages 2-3 ISH. [3][4][5] The recently reported positive effects of antihypertensive treatment on elderly patients with stages 2-3 ISH [23][24][25] will probably induce physicians to treat this type of patient in the future. By contrast, the decision to treat elderly people with stage 1 hypertension is less clear-cut because direct evidence of the benefit of antihypertensive therapy in such patients is still lacking.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] However, observational studies have shown that awareness, treatment and control of hypertension could be improved, especially in elderly people. [5][6][7][8] Furthermore, the recent recommendations to treat all 9 or part 10,11 of elderly patients with stage 1 hypertension might further increase the gap between the proposed guidelines and actual trends in the management of hypertension.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, awareness, treatment and control of hypertension in the elderly: results from a population survey

et al. 2000

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Prevalence, awareness, treatment and control of hypertension were assessed in 1032 (90%) of 1147 elderly (у65 years) inhabitants of three Italian villages. Blood pressure (BP) was measured at home on two separate occasions following a standardised protocol. Persons taking antihypertensive drugs or with BP values у140/90 mm Hg were considered as affected by hypertension. Prevalence of hypertension was 64.8%, with higher rates in women than men, and in those aged 75-84 than in those aged 65-74. Diabetes, strokes and hypercholesterolaemia were more frequent in hypertensive than normotensive people, whereas cardiac diseases, overweight and smoking did not differ significantly between hypertensive and normotensive people. Of the 669 hypertensive patients, 439 (65.6%) were aware of their hypertension, 398 (59.5%) were being treated, and 70 (10.5%) had their hypertension con-

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“…Since elderly men with isolated systolic hypertension are known to be at high risk of SCD [27] , it is important to note that an overview of the outcome trials in isolated systolic hypertension in the elderly identified a reduction in all-cause mortality of 17%, and myocardial infarction including SCD of 25% [31] . A meta-analysis of randomized controlled trials of blood pressure reduction mostly in middle-aged subjects with diastolic hypertension [32] found a risk reduction of 14% (95 C.I.…”

Section: Hypertension and Left Ventricular Hypertrophymentioning

confidence: 99%