Treatment of isolated systolic hypertension in the elderly: The Syst-Eur trial

The Syst-Eur study investigated whether active antihypertensive treatment c ould reduce cardiovascular complications in elderly patients with isolated systolic hypertension. Patients (greater than or equal to 60 years) were ra ndomly assigned to active treatment (n = 2398), i.e. nitrendipine, with the possible addition of enalapril and hydrochlorothiazide, or matching placeb os (n = 2297). In the intention-to-treat analysis, the between-group differ ence in blood pressure amounted to 10.1/4.5 mm Hg (P < 0.001). Active treat ment reduced the total incidence of stroke (primary endpoint) by 42% (P = 0 .003), of all cardiac endpoints by 26% (P = 0.03), and of all cardiovascula r endpoints combined by 31% (P < 0.001). Cardiovascular mortality was sligh tly lower on active treatment (-27%; P = 0.07), but all-cause mortality was not influenced (-14%; P = 0.22). For total (P = 0.009) and cardiovascular mortality (P = 0.09), the benefit of antihypertensive treatment weakened wi th advancing age and for total mortality it decreased with higher systolic blood pressure at entry (P = 0.05). The benefits of active treatment were n ot independently related to gender or to the presence of cardiovascular com plications at entry. Further analyses also suggested benefit in patients wh o were taking nitrendipine as the sole therapy. The per-protocol analysis l argely confirmed the intention-to-treat results. It can be concluded that s tepwise. antihypertensive drug treatment, starting with the dihydropyridine calcium channel blocker nitrendipine, improves prognosis:in elderly patien ts with isolated, systolic hypertension.