Treatment of isolated systolic hypertension in the elderly: evidence from three clinical trials

Abstract

Isolated systolic hypertension affects over 15% of all subjects older than 60 years. In the elderly, systolic hypertension is the major modifiable cardiovascular risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment for this disorder have been published. The aim of this article was to briefly review the main findings of each of these three trials and to present pooled estimates of the benefit of antihypertensive drug treatment in isolated systolic hypertension in the elderly. A total of 11 825 patients were enrolled in the Systolic Hypertension in the Elderly Program (SHEP; N=4736) in the United States, and in the Systolic Hypertension in Europe (Syst-Eur; N=4695) and the Systolic Hypertension in China (Syst-China; N=2394) trials. The outcome results of these trials were pooled by calculating the common odds ratio for active vs. placebo treatment. Overall, compared to placebo, active treatment reduced all-cause mortality by 17%, cardiovascular mortality by 25%, all cardiovascular endpoints by 32%, total stroke by 37%, and myocardial infarction including sudden death by 25%. Thus, the pooled results of the outcome trials in older patients with isolated systolic hypertension prove that antihypertensive drug treatment must be prescribed if, on repeated measurement, systolic blood pressure is 160 mmHg or higher.