Benefit of antihypertensive drug treatment in older patients with isolatedsystolic hypertension

Aims Isolated systolic hypertension affects 8-15% of all subjects older tha n 60 years. Systolic hypertension is the major modifiable cardiovascular ri sk factor in the elderly. Three placebo-controlled outcome trials on antihy pertensive drug treatment of this disorder have been published. The aim of this article is to review briefly each of these trials and to present the p ooled estimates of the benefits of antihypertensive drug treatment in isola ted systolic hypertension in the elderly. Methods and Results The Systolic Hypertension in the Elderly Program (SHEP) in the U.S.A., the Systolic Hypertension in Europe (SYST-EUR) trial and th e Systolic Hypertension in China (SYST-CHINA) trial published their main fi ndings in 1991, 1997 and 1998, respectively. The outcome results of these t rials were pooled by calculating the common odds ratios for active Versus p lacebo treatment for five major end-points. Zelen's exact test for homogene ity did not reach statistical significance for any of the end-points consid ered. Thus, the hypothesis of a common underlying treatment effect across t he three trials was not rejected. Overall, active treatment compared with p lacebo reduced all-cause mortality by 17%, cardiovascular mortality by 25%, all cardiovascular end-points by 32%, total stroke by 37% and myocardial i nfarction including sudden death by 25%. Conclusion The pooled results of the outcome trials in older patients with isolated systolic hypertension prove that antihypertensive drug treatment m ust be prescribed if, on repeated measurement, systolic blood pressure is 1 60 mmHg or higher.