Ramipril in isolated systolic hypertension of the elderly

This randomized, single-blinded, placebo-controlled study was performed to evaluate antihypertensive efficacy and tolerability of the angiotension-con verting enzyme (ACE) inhibitor ramipril in patients with isolated systolic hypertension (ISH). ISH is a common finding in the elderly population and i t is considered to be an important cardiovascular risk factor. After a 3-we ek mash-out, 84 patients aged between 65 and 86 years, with ISH defined as systolic blood pressure (SBP), greater than 160 mm Hg and diastolic blood p ressure (DBP) less than 90 mm Ng, mere randomized to placebo (r = 40) or ra mipril (n = 44) at the initial dose of 2.5 mg/day, which after 3 weeks of t reatment, was increased to 5 mg/day for another 9 weeks when SEP was greate r than 160 mm Hg or SEP decrease was less than 20 mm Hg. At baseline, the t wo groups were well matched for age, body weight, DBP, SEP, and heart rate. A total of 40 patients in the treated group and 34 controls completed the study. In the ramipril group, SEP decreased in a statistically significant manner from 180.5 to 168.1 (p ( 0.05) after 3 weeks and to 162.1 mm Hg (p < 0.02) after 12 weeks. In the placebo group, SBP decreased without statisti cal significance (p < 0.05) from 178.1 to 172.8 after 3 weeks and to 168.9 mm Hg after 12 weeks. Comparison between groups was statistically significa nt (p < 0.05) at twelve weeks. Patients' "responder" rate was 19.5% versus 46.3% after 3 weeks (p = 0.025) and 32.4% versus 70.0% after 12 weeks OI = 0.003) in the placebo and ramipril group, respectively. No effect was obser ved on DBP and heart rate and similar tolerability was seen in each group. The results of this placebo-controlled study underline the clinical efficac y, tolerability, and safety of ramipril for the treatment of elderly patien ts with ISH.