Treatment of isolated systolic hypertension is most effective in older patients with high-risk profile

Background-Although present guidelines suggest that treatment of hypertensi on is more effective in patients with multiple risk factors and higher risk of cardiovascular events, this hypothesis was never verified in older pati ents with systolic hypertension. Methods and Results-Using data from the Systolic Hypertension in the Elderl y Program, we calculated the global cardiovascular risk score according to the American Heart Association Multiple Risk Factor Assessment Equation in 4,189 participants free of cardiovascular disease (CVD) and in 264 particip ants with CVD at baseline. In the placebo group, rates of cardiovascular ev ents over 4.5 years were progressively higher according to higher quartiles of CVD risk. The protection conferred by treatment was similar across quar tiles of risk. However, the numbers needed to treat (NNTs) to prevent one c ardiovascular event were progressively smaller according to higher cardiova scular risk quartiles. In participants with baseline CVD, the NNTs to preve nt one cardiovascular event were similar to those estimated for CVD-free pa rticipants in the highest-risk quartile. Conclusions-Treatment of systolic hypertension is most effective in older p atients who, because of additional risk factors or prevalent CVD, are at hi gher risk of developing a cardiovascular event. These patients are prime ca ndidates for antihypertensive treatment.