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 .
Ambulatory monitoring uncorrected for placebo overestimates long-term antihypertensive action. Systolic Hypertension in Europe (SYST-EUR) Trial Investigators.
This study compares blood pressure ( BP ) changes during active antihypertensive treatment and placebo as assessed by conventional and ambulatory BP measurement . Older patients ( > or = 60 years , n=337 ) with isolated systolic hypertension by conventional sphygmomanometry at the clinic were r and omized to placebo or active treatment consisting of nitrendipine ( 10 to 40 mg/d ) , with the possible addition of enalapril ( 5 to 20 mg/d ) and /or hydrochlorothiazide ( 12.5 to 25 mg/d ) . At baseline , clinic systolic/diastolic BP averaged 175/86 mm Hg and 24-hour and daytime ambulatory BPs averaged 148/80 and 154/85 mm Hg , respectively . After 13 months ( median ) of active treatment , clinic BP had dropped by 22.7/7.0 mm Hg and 24-hour and daytime BPs by 10.5/4.5 and 9.7/4.3 mm Hg , respectively ( P<.001 for all ) . However , clinic ( 9.8/1.6 mm Hg ) , 24-hour ( 2.1/1.1 mm Hg ) , and daytime ( 2.9/1.0 mm Hg ) BPs decreased also during placebo ( P<.05 , except for daytime diastolic BP ) ; these decreases represented 43%/23 % , 20%/24 % , and 30%/23 % of the corresponding BP fall during active treatment . After subtraction of placebo effects , the net BP reductions during active treatment averaged only 12.9/5.4 , 8.3/3.4 , and 6.8/3.2 mm Hg for clinic , 24-hour , and daytime BPs , respectively . The effect of active treatment was also subject to diurnal variation ( P<.05 ) . Changes during placebo in hourly systolic and diastolic BP means amounted to ( median ) 21 % ( range , -1 % to 42 % ) and 25 % ( -3 % to 72 % ) , respectively , of the corresponding changes during active treatment . In conclusion , expressed in millimeters of mercury , the effect of antihypertensive treatment on BP is larger with conventional than with ambulatory measurement . Regardless of whether BP is measured by conventional sphygmomanometry or ambulatory monitoring , a substantial proportion of the long-term BP changes observed during active treatment may be attributed to placebo effects . Thus , ambulatory monitoring uncorrected for placebo or control observations , like conventional sphygmomanometry , overestimates BP responses in clinical trials of long duration
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 .