ANTIHYPERTENSIVE THERAPY IN OLDER PATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION - THE SYST-EUR EXPERIENCE IN GENERAL-PRACTICE

Background and objective. This interim report from the Syst-Eur trial investigated the level of blood pressure control achieved during the d ouble-blind period in patients followed in general practices. Methods. In the Syst-Eur trial elderly patients (60 years or older) with isola ted systolic hypertension were randomized to either active or placebo treatment. Active treatment consisted of nitrendipine combined with en alapril and/or hydrochlorothiazide to reduce systolic pressure to < 15 0 mmHg and by greater than or equal to 20 mmHg. Matching placebos were used in the control group. Results. This analysis was restricted to p atients of general practitioners who had been followed for at least 12 months. The placebo (N = 204) and active treatment (N = 217) groups h ad similar characteristics at randomization. At one year, the differen ce in sitting pressure between the two treatment groups was 10 mmHg sy stolic and 4 mmHg diastolic. Fewer patients remained on monotherapy in the placebo than in the active treatment group and on placebo the sec ond and third line medications were started earlier. Nitrendipine tabl ets were discontinued in 10 patients on placebo and in 21 patients ass igned to active treatment (P < 0.001 for all comparisons). Conclusions . A significant blood pressure reduction can be achieved and maintaine d in older patients with isolated systolic hypertension followed by ge neral practitioners. Whether this blood pressure reduction results in a clinically meaningful decrease of cardiovascular complications is un der investigation.