September 5, 2000Circulation285 citationsOpen Access

Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension

RFRobert Fagard JSJan A. Staessen LTLutgarde Thijs

Structured PICO

Does antihypertensive therapy reduce blood pressure, ECG voltages, stroke, and cardiovascular events in older patients with sustained versus nonsustained systolic hypertension?

Population

Patients ≥60 years old with systolic clinic blood pressure 160-219 mm Hg and diastolic clinic blood pressure <95 mm Hg, classified by daytime systolic ambulatory blood pressure into nonsustained (<140 mm Hg), mild sustained (140-159 mm Hg), and moderate sustained (≥160 mm Hg) hypertension.

Intervention

Active antihypertensive treatment consisting of nitrendipine, with the possible addition of enalapril, hydrochlorothiazide, or both.

Comparator

Matching placebo.

Outcome

Effect on clinic (CBP) and ambulatory (ABP) blood pressures, ECG voltages, incidence of stroke, and cardiovascular events.

Antihypertensive therapy provides significant clinical benefits primarily in older patients with moderate sustained systolic hypertension, whereas those with nonsustained (white-coat) hypertension may not derive the same cardiovascular event reduction.

Abstract

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 /=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.

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