Use of dihydropyridines for antihypertensive treatment in older patients: evidence from the Systolic Hypertension in Europe trial

Journal of Clinical and Basic Cardiology 2000; 3 (1): 15-21

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Keywords: alter Mensch,  Demenz,  Diabetes mellitus,  Dihydropyridin,  isolierte systolische Hypertonie,  Kalziumkanalblocker,  Nitrendipin,  calcium channel blocker,  dementia,  Diabetes mellitus,  dihydropyridine,  elderly,  isolated systolic hypertension,  nitrendipine

The Syst-Eur study investigated whether active antihypertensive treatment could reduce cardiovascular complications in elderly patients with isolated systolic hypertension. Patients (>= 60 years) were randomly assigned to active treatment (n = 2398), ie, nitrendipine, with the possible addition of enalapril and hydrochlorothiazide, or to matching placebos (n = 2297). In the intention-to-treat analysis, the between-group difference in blood pressure amounted to 10.1/4.5 mmHg (p < 0.001). Active treatment reduced the incidence of fatal and nonfatal stroke (primary endpoint) by 42 % (p = 0.003). On active treatment all cardiac endpoints decreased by 26 % (p = 0.03) and all cardiovascular endpoints by 31 % (p < 0.001). Cardiovascular mortality was slightly lower on active treatment (-27 %; p = 0.07), but all-cause mortality was not influenced (-14 %; p = 0.22). For total (p = 0.009) and cardiovascular mortality (p = 0.09), the benefit of antihypertensive treatment weakened with advancing age and for total mortality it decreased with lower systolic blood pressure at entry (p = 0.05). The benefits of active treatment were not independently related to sex or to the presence of cardiovascular complications at entry. The antihypertensive regimen was more effective in patients with diabetes than in those without diabetes at entry. Further analyses also suggested benefit in patients who were taking nitrendipine as the sole therapy. The per-protocol analysis largely confirmed the intention-to-treat results. Active treatment reduced all strokes by 44 % (p = 0.004), all cardiac endpoints by 26 % (p = 0.05) and all cardiovascular endpoints by 32 % (p < 0.001). Total mortality was reduced by 26 % (p = 0.05), but a similar reduction in cardiovascular mortality did not reach statistical significance in this analysis. Compared with placebo, active treatment also reduced the incidence of dementia by 50 %. Stepwise antihypertensive drug treatment, starting with the dihydropiridine calcium-channel blocker nitrendipine, improves prognosis in elderly patients with isolated systolic hypertension. J Clin Basic Cardiol 2000; 3: 15-21.