Outcome trials in older patients with isolated systolic hypertension

Aims Previous meta-analyses of outcome trials in hypertension did not speci fically focus on isolated systolic hypertension. We therefore performed a q uantitative overview of the trials to further evaluate the relative benefit associated with treatment of isolated systolic hypertension. Methods and Results Patients were greater than or equal to 60 years old. Sy stolic pressure was greater than or equal to 160 mmHg and diastolic pressur e was <95 mmHg. We computed pooled effects of treatment from stratified 2 x 2 contingency tables after application of Zelen's test of heterogeneity. I n eight trials 15 693 patients were followed-up for 3.8 years (median). Act ive treatment achieved mean blood pressure decreases of 10.4 mmHg systolic and 4.1 mmHg diastolic. A common treatment effect existed across the trials . Active treatment reduced total mortality by 13% (P=0.02), cardiovascular mortality by 18% (P=0.01), all cardiovascular complications by 26% (P<0.000 1), stroke by 30% (P<0.0001) and coronary events by 23% (P=0.001). Conclusion The pooled results of the outcome trials in older patients with isolated systolic hypertension prove that drug treatment is justified if, o n repeated measurement, systolic blood pressure is 160 mmHg or higher.