Nitrendipine in older patients with isolated systolic hypertension: second progress report on the SYST-EUR trial.

Abstract

This report from the double-blind placebo-controlled SYST-EUR trial investigated whether modern antihypertensive drugs are suitable for maintaining long-term BP control in older (> or = 60 years of age) subjects with isolated systolic hypertension (SBP 160-219 mmHg and DBP < 95 mmHg). Active treatment consisted of nitredipine (10-40 mg/day) with the possible addition of enalapril (5-20 mg/day) and hydrochlorothiazide (12.5-25 mg/day), if necessary to reduce SBP to < 150 mmHg and by > or = 20 mmHg. Matching placebos were used in the control group. This analysis was restricted to 18 months of follow-up. The placebo (n = 456) and active treatment (n = 485) groups had similar characteristics at randomisation (sitting pressure 176/85 mmHg; age 73 years). SBP fell (P < 0.001) on average 10 mmHg more on active treatment than on placebo and DBP 4 mmHg more. Fewer patients remained on monotherapy in the placebo than in the active treatment group (P < 0.001); on placebo the second and third line medications were started earlier (P < 0.001). Nitrendipine tablets were discontinued in nine patients on placebo and in 29 patients assigned to active treatment (P < 0.001). In conclusion, a significant BP reduction can be achieved and maintained in older patients with isolated systolic hypertension treated with a calcium antagonist (associated with a converting-enzyme inhibitor and a thiazide, where necessary). Whether this BP reduction results in a clinically meaningful decrease of cardiovascular complications is under investigation.

• Authors: J Staessen, P Bert, C Bulpitt, P De Cort, R Fagard, A Fletcher, P Kivinen, E Lehtomaki, G Leonetti, E O'Brien
• Journal: Journal of human hypertension (J Hum Hypertens) Vol. 7 Issue 3 Pg. 265-71 (Jun 1993) ISSN: 0950-9240 [Print] England
• PMID: 8345494 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Hydrochlorothiazide
• Enalapril
• Nitrendipine

Topics

• Aged
• Blood Pressure (drug effects)
• Double-Blind Method
• Drug Therapy, Combination
• Enalapril (therapeutic use)
• Female
• Follow-Up Studies
• Heart Rate (drug effects)
• Humans
• Hydrochlorothiazide (therapeutic use)
• Hypertension (drug therapy, physiopathology)
• Male
• Middle Aged
• Nitrendipine (adverse effects, therapeutic use)