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 .
A prospective, double-blind, randomized controlled trial of the angiotensin-converting enzyme inhibitor Ramipril In Aortic Stenosis (RIAS trial)
Aims Angiotensin-converting enzyme ( ACE ) inhibitors improve left ventricular ( LV ) remodelling and outcome in heart failure and hypertensive heart disease . They may be similarly beneficial in patients with aortic stenosis ( AS ) , but historical safety concerns have limited their use , and no prospect i ve clinical trials exist . Methods and results We conducted a prospect i ve , r and omized , double-blind , placebo-controlled trial in 100 patients with moderate or severe asymptomatic AS to examine the physiological effects of ramipril , particularly LV mass ( LVM ) regression . Subjects were r and omized to ramipril 10 mg daily ( n = 50 ) or placebo ( n = 50 ) for 1 year , and underwent cardiac magnetic resonance , echocardiography , and exercise testing at 0 , 6 , and 12 months , with follow-up data available in 77 patients . There was a modest but progressive reduction in LVM ( the primary end point ) in the ramipril group vs. the placebo group ( mean change −3.9 vs. + 4.5 g , respectively , P = 0.0057 ) . There were also trends towards improvements in myocardial physiology : the ramipril group showed preserved tissue Doppler systolic velocity compared with placebo ( + 0.0 vs. −0.5 cm/s , P = 0.04 ) , and a slower rate of progression of the AS ( valve area 0.0 cm2 in the ramipril group vs. −0.2 cm2 in the placebo arm , P = 0.067 ) . There were no significant differences in major adverse cardiac events . Conclusion ACE inhibition leads to a modest , but progressive reduction in LVM in asymptomatic patients with moderate – severe AS compared with placebo , with trends towards improvements in myocardial physiology and slower progression of valvular stenosis . A larger clinical outcome trial to confirm these findings and explore their clinical relevance is required
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 .