Subgroup and Per-Protocol Analysis of the Randomized European Trial on Isolated Systolic Hypertension in the Elderly

Staessen, Jan A.; Fagard, Robert; Thijs, Lutgarde; Celis, Hilde; Birkenhäger, W. H.; Bulpitt, CJ; Leeuw, Peter W. de; Fletcher, Astrid; Babarskiene, M.R.; Forette, Françoise; Kocemba, J; Laks, Toivo; Leonetti, Gastone; Nachev, C; Petrie, J C; Tuomilehto, Jaakko; Vanhanen, Hannu; Webster, J; Yodfat, Y; Zanchetti, Alberto

doi:10.1001/archinte.158.15.1681

Cited by 124 publications

(76 citation statements)

References 33 publications

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“…42 However, the Syst-Eur trial evidenced a significant reduction in morbidity but not in mortality in this age group. 53 Gueyffier et al (1999), 54 in a meta-analysis of data from 1670 participants over 80, suggested that treatment of very old hypertensive patients prevented stroke by 34% (95% CI 8-52). Rates of major cardiovascular events and heart failure were significantly decreased, by 22% and 39% respectively.…”

Section: Treatment Of Hypertension In the Elderlymentioning

confidence: 99%

Cerebral complications of hypertension

Rigaud

Staessen

et al. 2000

J Hum Hypertens

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Ischaemic and degenerative brain diseases are a major health problem leading to a devastating loss of autonomy. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality but also for cognitive impairment and dementia. Although diastolic blood pressure is considered an important risk factor, it is now clear that isolated systolic hypertension and elevated pulse pressure also play an important role in the development of brain complications. Therefore the treatment of these conditions must urgently become a widespread tool of prevention. All the randomised placebo-controlled trials completed for the last 30 years have shown a reduction in fatal and/or non-fatal strokes. In the most recent trials in isolated systolic hypertension in older patients, the benefit was even greater because of the higher risk in these populations. The new classes of drugs, in particular, calcium-channels blockers and angiotensin-

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Section: Treatment Of Hypertension In the Elderlymentioning

confidence: 99%

Cerebral complications of hypertension

Rigaud

Staessen

et al. 2000

J Hum Hypertens

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“…6 -10 For example, treatment appears to be less effective in very elderly people with isolated systolic hypertension. 10 It is possible that people who survive to 80 years and older, a select group, might be somewhat tolerant of high blood pressure. The presence of target-organ damage in very elderly HT subjects would not be consistent with the notion that HT is a benign condition in this age group.…”

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confidence: 99%

Hypertensive Target-Organ Damage in the Very Elderly

et al. 2003

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Abstract-In people aged Ͼ80 years, the so-called very elderly, there is uncertainty about the relation between hypertension and cardiovascular morbidity. The aims of this study were to investigate whether hypertension in people aged Ͼ80 years is associated with target-organ damage, over and above the effects of age, and to determine whether ambulatory blood pressure monitoring (ABPM) could improve on conventional blood pressure monitoring (CBPM) in predicting target-organ damage. Investigations included echocardiographic measurement of left ventricular mass index (LVMI), brain magnetic resonance imaging assessment of periventricular hyperintensity (PVH), urinary albumin-creatinine ratio (ACR), aortic pulse wave velocity (PWV), and 24-hour ABPM. Forty-three subjects, at a mean age 84.3 years, were studied, 22 normotensive (NT) and 21 hypertensive (HT). CBP was 184/89 and 145/76 mm Hg in the HT and NT groups, respectively. In men, LVMI was significantly greater in HT subjects, 157Ϯ37 vs 123Ϯ15 g/m 2 in NT subjects (PϽ0.05). In women, LVMI was similar in both groups. Urinary ACR was greater in HT than in NT subjects (log ACR, 1.21Ϯ0.50 vs 0.95Ϯ0.23; PϽ0.05). Cerebral PVH grade was higher in the HT subjects (2.6Ϯ0.8 vs 2.2Ϯ0.9), although this difference was not significant. Aortic PWV did not differ between the 2 groups. ABPM was positively associated with urinary ACR and cerebral PVH, independent of its correlation with CBPM. In advanced old age, HT is associated with evidence of target-organ damage. ABPM can improve on CBPM in predicting very elderly subjects with HT target-organ damage.

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“…7,11,12 In view of the remaining uncertainties with regard to the treatment of isolated systolic hypertension in the elderly, [13][14][15][16][17] the SystEur trial continued after the publication of the SHEP results. 9 Furthermore, the recent controversy on the role of calcium channel blockers as first-line antihy- pertensive agents 18,19 highlighted the lack of evidence that also this newer class of drugs could reduce cardiovascular risk.…”

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confidence: 99%

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

et al. 1999

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Aims: Isolated systolic hypertension affects over 8 to 15% of all subjects older than 60 years. In the elderly, systolic hypertension is the major modifiable cardiovascular risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment of this disorder have been published. The aim of this article was to shortly review each of these three trials and to present the pooled estimates of benefit of antihypertensive drug treatment in isolated systolic hypertension in the elderly. Methods and results: The Systolic Hypertension in the Elderly Program (SHEP) in the United

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Subgroup and Per-Protocol Analysis of the Randomized European Trial on Isolated Systolic Hypertension in the Elderly

Cited by 124 publications

References 33 publications

Cerebral complications of hypertension

Cerebral complications of hypertension

Hypertensive Target-Organ Damage in the Very Elderly

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

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