Trials in isolated systolic hypertension: An update

Abstract

Isolated systolic hypertension (ISH) has proved to be a powerful predisposing factor for cardiovascular diseases in the elderly. Recent placebo-controlled interventional trials such as the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur), and the Systolic Hypertension in China (Syst-China) showed that the lowering of systolic blood pressure using a diuretic- or a calcium antagonist-based treatment is associated with a decrease in cardiovascular events. Antihypertensive therapy was found especially effective in preventing stroke in the elderly with ISH. A slowing in the progression of dementia was observed in patients randomized to a calcium antagonist-based treatment. Patients at high cardiovascular risk such as those with diabetes benefited the most from treatment. In another trial performed in patients with left ventricular hypertrophy (Losartan Intervention For Endpoint Reduction ), a subset of patients had ISH. In those patients, an angiotensin II antagonist-based treatment was superior to a b-blocker-based treatment in preventing cardiovascular complications. The experience accumulated in patients with ISH showed that combination therapy is often required to control blood pressure. Overall, the evidence available today indicates that pharmacologic treatment of ISH markedly improves the outcome of elderly patients.

The evolution of systolic blood pressure as a strong predictor of cardiovascular risk and the effectiveness of fixed-dose ARB/CCB combinations in lowering levels of this preferential target

“…Isolated systolic hypertension is thus likely to become increasingly prevalent since aging of the population is a feature of both developed and developing countries (Kalache and Keller 2000). Isolated systolic hypertension is associated with a high risk of cardiovascular events such as stroke (SHEP 1991; Staessen et al 1997; Liu et al 1998; Inoue et al 2007), and the incidence of such complications can be significantly reduced by effective antihypertensive treatment (SHEP 1991; Staessen et al 1997, 2000; Liu et al 1998; Waeber 2003). Approximately 281,000 unnecessary cardiovascular events could be prevented, with a healthcare system cost saving of €1.26 billion (based upon 2002 costing), if the BP of all patients with hypertension in five European countries (France, Germany, Italy, Sweden, and the United Kingdom) was reduced to < 140/90 mmHg (Hansson et al 2002).…”

“…Given the relationship between arterial stiffness and cognitive impairment (Hanon et al 2005), such agents may also lead to improvements in cognitive function in elderly patients. Improvements in cognitive function/reduced rate of decline in elderly patients have been suggested for CCBs and ARBs (Waeber 2003; Hanon et al 2006 Shlyakhto 2007). …”

Hypertonie im hohen Alter - eine Beobachtungsstudie von Krankheitsverläufen in vier Praxen

“…Lebensjahr aufgenommen (1,2,3,5). Eine Studie mit noch älteren Patienten ist erst in der Anfangsphase bzw.…”

Distinct effects of amlodipine treatment on vascular elastocalcinosis and stiffness in a rat model of isolated systolic hypertension

“…It is thus not surprising that antihypertensive drugs that are effective in reducing blood pressure in patients with ISH significantly improve outcomes [13]. Calcium channel blockers (CCB) have been shown to reduce cardiovascular mortality in the elderly with ISH [14].…”