The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity .
AUTHORS ' CONCLUSIONS Treating healthy adults 60 years or older with moderate to severe systolic and /or diastolic hypertension with antihypertensive drug therapy reduced all-cause mortality , cardiovascular mortality and morbidity , cerebrovascular mortality and morbidity , and coronary heart disease mortality and morbidity .
Most evidence of benefit pertains to a primary prevention population using a thiazide as first-line treatment
BACKGROUND This is the second substantive up date of this review .
It was originally published in 1998 and was previously up date d in 2009 .
Elevated blood pressure ( known as ' hypertension ' ) increases with age - most rapidly over age 60 .
Systolic hypertension is more strongly associated with cardiovascular disease than is diastolic hypertension , and it occurs more commonly in older people .
It is important to know the benefits and harms of antihypertensive treatment for hypertension in this age group , as well as separately for people 60 to 79 years old and people 80 years or older .
Effects of Blood Pressure Lowering in Patients with Acute Ischemic Stroke and Carotid Artery Stenosis
Background The Sc and inavian C and esartan Acute Stroke Trial ( SCAST ) showed no beneficial clinical effects of blood pressure lowering with the angiotensin receptor blocker c and esartan in the acute phase of stroke . In the present analysis we wanted to see if the effects of blood pressure lowering are harmful in the subgroup of patients with carotid artery stenosis . Methods SCAST was a r and omized- and placebo-controlled , double-masked trial of 2029 patients with acute stroke and high systolic blood pressure ( ≥140 mmHg ) . Of 1733 patients with ischemic stroke 993 underwent carotid artery imaging  , and the degree of stenosis was categorized as no/insignificant ( 0–49 % , n = 806 ) , moderate ( 50–69 % , n = 97 ) or severe ( = 70 % , n = 90 ) . The trial 's two co- primary effect variables were the composite end-point of vascular death , stroke or myocardial infa rct ion , and functional outcome at six-months , according to the modified Rankin Scale . Results Among patients with moderate or severe carotid artery  stenosis the vascular end-point occurred in 9 of 87 patients ( 10·3 % ) treated with c and esartan and in 17 of 100 controls ( 17·0 % ) , and there was no evidence of a different risk in patients with severe stenosis ( adjusted hazard ratio 0·74 , 95 % confidence interval 0·28–1·96 , P = 0·54 ) . For functional outcome there was also no clear difference , although in patients with severe stenosis the risk of a poor outcome was somewhat higher than in any of the other groups ( adjusted odds ratio 2·24 , 95 % confidence interval 0·71–7·09 , P = 0·16 ) . Progressive stroke also occurred more often in patients with carotid artery stenosis treated with c and esartan ( 10 of 87 patients ( 11·5 % ) vs. 4 of 100 patients ( 4·0 % ) ) , with a trend towards an increased risk with increasing severity of stenosis ( P-value for linear trend = 0·04 ) . Conclusions There is no clear evidence that the effect of c and esartan is qualitatively different in patients with carotid artery stenosis , but there are signals that patients with severe stenosis are at particularly high risk of stroke progression and poor functional outcome
The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity .
AUTHORS ' CONCLUSIONS Treating healthy adults 60 years or older with moderate to severe systolic and /or diastolic hypertension with antihypertensive drug therapy reduced all-cause mortality , cardiovascular mortality and morbidity , cerebrovascular mortality and morbidity , and coronary heart disease mortality and morbidity .
Most evidence of benefit pertains to a primary prevention population using a thiazide as first-line treatment
BACKGROUND This is the second substantive up date of this review .
It was originally published in 1998 and was previously up date d in 2009 .
Elevated blood pressure ( known as ' hypertension ' ) increases with age - most rapidly over age 60 .
Systolic hypertension is more strongly associated with cardiovascular disease than is diastolic hypertension , and it occurs more commonly in older people .
It is important to know the benefits and harms of antihypertensive treatment for hypertension in this age group , as well as separately for people 60 to 79 years old and people 80 years or older .