Implications of the systolic hypertension in China trial

In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Grou p started to investigate whether active treatment could reduce the incidenc e of stroke and other cardiovascular complications of isolated systolic hyp ertension. After stratification for center, sex and previous cardiovascular complications, alternate patients (n = 1253) were assigned nitrendipine 10 -40 mg daily, with the possible addition of captopril 12.5-50.0 mg daily, o r hydrochlorothiazide 12.5-50.0 mg daily, or both drugs. In 1141 control pa tients, matching placebos were employed similarly. At entry, sitting blood pressure averaged 170 mm Hg systolic and 86 mm Hg diastolic, age averaged 6 6 years, and total serum cholesterol was 5.1 mmol/L. At 2 years, the betwee n-group differences were 9.1 mm Hg systolic (95% confidence interval. 7.6-1 0.7 mm Hg) and 3.2 mm Hg diastolic (2.4-4.0). Active treatment reduced tota l stroke by 38% (p=0.01), all-cause mortality by 39% (p=0.003), cardiovascu lar mortality by 39% (p=0.03), stroke mortality by 58% (p=0.02) and all fat al and nonfatal cardiovascular endpoints by 37% (p=0.004). In conclusion, a ntihypertensive treatment prevents stroke and other cardiovascular complica tions in older Chinese patients with isolated systolic hypertension. Treatm ent of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 stroke s, or 59 major cardiovascular endpoints.