Risk and benefit of treatment of isolated systolic hypertension in the elderly: evidence from the Systolic Hypertension in Europe Trial

The Syst-Eur trial investigated whether active treatment starting with the dihydropyridine calcium channel blocker (CCB) nitrendipine, could reduce th e cardiovascular complications of isolated systolic hypertension (ISH) in t he elderly. The intention-to-treat analysis showed that active treatment im proved outcome. The per-protocol analysis largely confirmed these results. The effect of treatment on total and cardiovascular mortality might be atte nuated in very old patients. Further analysis also suggested benefit in tho se patients who remained on nitrendipine monotherapy. Active treatment was more beneficial in patients with diabetes as compared with those without di abetes at entry and reduced the incidence of dementia by 50%. Analyses of d ata from the Ambulatory Blood Pressure Monitoring (ABPM) Side Project sugge sted that most of the benefit of treatment was seen in patients with a dayt ime systolic BP greater than or equal to 160 mm Hg. Finally, a meta-analysi s partly based on Syst-Eur data showed that in older hypertensive patients pulse pressure and not mean pressure is the major determinant of cardiovasc ular risk. (C) 2001 Lippincott Williams & Wilkins, Inc.