Ambulatory pulse pressure aspredictor of outcome in older patients with systolic hypertension
Key result
A 10 mm Hg increase in 24-h ambulatory pulse pressure predicted total and cardiovascular mortality, stroke, and cardiac events in the placebo group (HR 1.25 to 1.68), but this relation was attenuated by active treatment.
Why the study?
Does ambulatory pulse pressure predict adverse outcomes better than conventional pulse pressure in older patients with isolated systolic hypertension?
Population
808 older patients (≥60 years) with isolated systolic hypertension (160 to 219/71 <95 mm Hg)
Comparison
Nitrendipine with the possible addition of… vs Matching placebos
Design
RCT, Randomized, Placebo-controlled (matching placebos)
Authors
Discussion
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Implication
Ambulatory pulse pressure may refine risk stratification in older isolated systolic hypertension; extends conventional BP prognostic data from treatment trial participants.
Study Design
Type
RCT (n=808)
Blinding
Placebo-controlled
Randomization
Randomized
Structured PICO
Does ambulatory pulse pressure predict adverse outcomes better than conventional pulse pressure in older patients with isolated systolic hypertension?
P
Population
808 older patients (≥60 years) with isolated systolic hypertension randomized to nitrendipine-based therapy or placebo to evaluate ambulatory pulse pressure as a risk predictor.
I
Intervention
Nitrendipine (10 to 40 mg/day) with the possible addition of enalapril (5 to 20 mg/day) or hydrochlorothiazide (12.5 to 25 mg/day)
C
Comparator
Matching placebos
O
Outcome
Total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac eventshard clinical
Main Result
Effect estimate: HR 1.25 to 1.68 (per 10 mm Hg increase in pulse pressure)
Ambulatory 24-hour pulse pressure is a superior predictor of adverse cardiovascular outcomes compared to conventional pulse pressure in older patients with isolated systolic hypertension.
Cite This Study
Jan A. Staessen (2002) conducted an RCT in Isolated systolic hypertension (n=808). Nitrendipine (with possible addition of enalapril or hydrochlorothiazide) vs. Matching placebos was evaluated on Total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac events (HR 1.25 to 1.68 (per 10 mm Hg increase in pulse pressure)). A 10 mm Hg increase in 24-h ambulatory pulse pressure predicted total and cardiovascular mortality, stroke, and cardiac events in the placebo group (HR 1.25 to 1.68), but this relation was attenuated by active treatment.