One-year study of felodipine or placebo for stage 1 isolated systolic hypertension

A substantial number of older hypertensive patients have stage 1 isolated s ystolic hypertension (systolic blood pressure between 140 and 159 mm Hg and diastolic blood pressure < 90 min Hg), but there are currently no data sho wing that drug treatment is effective, safe, and/or beneficial. To compare the effects of active treatment compared with placebo on blood pressure, le ft ventricular hypertrophy, and quality of life among older stage 1 isolate d systolic hypertensive patients, a randomized, double-blind, parallel-grou p, multicenter clinical trial comparing felodipine (2.5. 5, or 10 mg once d aily) and matching placebo was performed in 171 patients (49% male, average age 66 +/-7 years, with 49% white and 30% Hispanic) with a baseline blood pressure of 149 +/-7/83 +/-6 mm Fig. During 52 weeks of treatment, patients randomized to active treatment achieved significantly lower blood pressure s (137.0 +/- 11.7/80.2 +/-7.6 mm Hg for extended-release felodipine versus 147.5 +/- 16.0/83.5 +/-9.7 mm Hg for placebo, P <0.01 for each), a reduced incidence of left ventricular hypertrophy (7% for extended release felodipi ne versus 24% for placebo, P <0.04), and improved quality of life (change i n Psychological General Well-Being index, 3.0 +/-6.8 for extended-release f elodipine versus -0.8 +/- 10.3 for placebo, P <0.01) versus baseline. There were no clinically significant differences between treatments in tolerabil ity or adverse effects. Stage 1 isolated systolic hypertension can be effec tively and safely treated pharmacologically. Treatment reduced progression to the higher stages of hypertension, reduced the incidence of left ventric ular hypertrophy, and improved an overall measure of the quality of life. L arger and longer studies will be needed to document any long-term reduction in cardiovascular event rates associated with treating stage 1 systolic hy pertension.