Clinical Briefs
By Louis Kuritzky, MD
Risks of Untreated Isolated Systolic Hypertension in the Elderly
The ascendancy of systolic blood pressure over diastolic as a predictor of adverse cardiovascular outcomes has only recently been popularized. Most recent meta-analyses have focused upon large accumulated data derived from prospective randomized trials that used diastolic blood pressure as the primary measurement tool. In the last decade, three large randomized trials of treatment for isolated systolic hypertension have each demonstrated cardiovascular risk reduction. The large amount of patient experience generated by these trials allows for commentary based upon a meta-analysis of trials limited to systolic hypertension.
Staessen and colleagues included older patient populations (age > 60) with isolated systolic hypertension from the SHEP, Syst-Eur, and the Syst-China trials. Additionally, persons with isolated systolic hypertension that participated in the EWPHE, HEP, STOP, MRC-1, and MRC-2 trials were included in the analysis.
Assessing data of these trials for patients followed for a median of 3.8 years (n = 15,693) demonstrated a total mortality reduction of 13%, cardiovascular mortality reduction of 18%, stroke reduction of 30%, and coronary event reduction of 23%. These favorable effects of treatment are similar to those achieved in the large body of diastolic based hypertension trials. This meta-analysis concludes that treatment of isolated systolic hypertension is of substantial benefit in older patients.
Staessen JA, et al. Lancet 2000;355: 865-872.
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