Treatment of systolic hypertension in older patients yielded progressively smaller numbers needed to treat to prevent one cardiovascular event in higher-risk quartiles over 4.5 years.
Observational (n=4,453)
Does antihypertensive treatment reduce cardiovascular events more effectively in older patients with isolated systolic hypertension who have a higher baseline cardiovascular risk profile?
Antihypertensive treatment in older patients with isolated systolic hypertension yields the greatest absolute benefit (lowest NNT) in those with the highest baseline cardiovascular risk or prevalent CVD.
BACKGROUND: Although present guidelines suggest that treatment of hypertension is more effective in patients with multiple risk factors and higher risk of cardiovascular events, this hypothesis was never verified in older patients with systolic hypertension. METHODS AND RESULTS: Using data from the Systolic Hypertension in the Elderly Program, we calculated the global cardiovascular risk score according to the American Heart Association Multiple Risk Factor Assessment Equation in 4,189 participants free of cardiovascular disease (CVD) and in 264 participants with CVD at baseline. In the placebo group, rates of cardiovascular events over 4.5 years were progressively higher according to higher quartiles of CVD risk. The protection conferred by treatment was similar across quartiles of risk. However, the numbers needed to treat (NNTs) to prevent one cardiovascular event were progressively smaller according to higher cardiovascular risk quartiles. In participants with baseline CVD, the NNTs to prevent one cardiovascular event were similar to those estimated for CVD-free participants in the highest-risk quartile. CONCLUSIONS: Treatment of systolic hypertension is most effective in older patients who, because of additional risk factors or prevalent CVD, are at higher risk of developing a cardiovascular event. These patients are prime candidates for antihypertensive treatment.
Ferrucci et al. (Tue,) conducted a observational in Isolated Systolic Hypertension (n=4,453). Antihypertensive treatment vs. Placebo was evaluated on Cardiovascular events. Treatment of systolic hypertension in older patients yielded progressively smaller numbers needed to treat to prevent one cardiovascular event in higher-risk quartiles over 4.5 years.