(Circulation. 2000;102:1139.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension
From the Hypertension and Cardiovascular Rehabilitation Unit (R.H.F., J.A.S., L.T., J.G.), Catholic University of Leuven, Leuven, Belgium; Imperial College (C.J.B.), Hammersmith Hospital, London, UK; Department of Cardiology (D.C.), University of Gent, Gent, Belgium; Department of Internal Medicine (P.W.d.L.), University of Maastricht, Maastricht, the Netherlands; Hypertension Division (J.D.), University Medical Center, Ljubljana, Slovenia; Department of Epidemiology and Health Promotion (M.J.), National Public Health Institute, Helsinki, Finland; Istituto Auxologico Italiano (G.L., G.P.), Ospedale San Luca, Milano, Italy; Beaumont Hospital (E.O.), Dublin, Ireland; Clinica Medica IV (P.P.), Universitá di Padova, Padova, Italy; Hospital "12de Octubre" (J.L.R.), Madrid, Spain; Department of Medicine (H.V.), Helsinki University Central Hospital, Helsinki, Finland; and Department of Medicine and Therapeutics (J.W.), University of Aberdeen, Aberdeen, UK.
Correspondence to R. Fagard, MD, PhD, Department of Medicine, U.Z. Gasthuisberg–Hypertensie, Herestraat 49 B-3000, Leuven, Belgium. E-mail robert.fagard{at}uz.kuleuven.ac.be
Background—The goal of the present study was to assess the effect of antihypertensive therapy on clinic (CBP) and ambulatory (ABP) blood pressures, on ECG voltages, and on the incidence of stroke and cardiovascular events in older patients with sustained and nonsustained systolic hypertension.
Methods and Results—Patients who were 
60 years old, with
systolic CBP of 160 to 219 mm Hg and
diastolic CBP of <95 mm Hg, were randomized into the
double-blind placebo-controlled Systolic Hypertension in Europe
(Syst-Eur) Trial. Treatment consisted of nitrendipine, with the
possible addition of enalapril, hydrochlorothiazide, or
both. Patients enrolled in the Ambulatory Blood Pressure Monitoring
Side Project were classified according to daytime systolic
ABP into 1 of 3 subgroups: nonsustained hypertension (<140
mm Hg), mild sustained hypertension (140 to 159 mm Hg), and
moderate sustained hypertension (160 mm Hg). At baseline,
patients with nonsustained hypertension had smaller ECG voltages
(P<0.001) and, during follow-up, a lower incidence of
stroke (P<0.05) and of cardiovascular
complications (P=0.01) than other groups. Active
treatment reduced ABP and CBP in patients with sustained hypertension
but only CBP in patients with nonsustained hypertension
(P<0.001). The influence of active treatment on ECG
voltages (P<0.05) and on the incidence of stroke
(P<0.05) and cardiovascular events
(P=0.06) was more favorable than that of placebo only in
patients with moderate sustained hypertension.
Conclusions—Patients with sustained hypertension had higher ECG voltages and rates of cardiovascular complications than did patients with nonsustained hypertension. The favorable effects of active treatment on these outcomes were only statistically significant in patients with moderate sustained hypertension.
Key Words: blood pressure monitoring • aging • hypertrophy, left ventricular • prognosis • hypertension, white coat • trials
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