Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials

@article{Staessen2000RisksOU,
  title={Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials},
  author={Jan A. Staessen and Jerzy Gąsowski and Ji G. Wang and Lutgarde Thijs and Elly Den Hond and Jean-Pierre Boissel and J. A. R. Coope and Tork Ekbom and François Gueyffier and Li-sheng Liu and Karla Kerlikowske and Stuart Pocock and Robert H. Fagard},
  journal={The Lancet},
  year={2000},
  volume={355},
  pages={865-872}
}
The benefit of treating isolated systolic hypertension
TLDR
The pooled results of 15,693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment is justified if systolics blood pressure on repeated clinic measurements is 160 mm Hg or higher.
Improved Outcomes with Antihypertensive Medication in the Elderly with Isolated Systolic Hypertension
TLDR
The pooled results of 15 693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment is justified if on repeated clinic measurements SBP is 160mm Hg or higher.
Treatment strategies for isolated systolic hypertension in elderly patients
TLDR
The authors systematically review published studies to appraise the scientific and clinical evidence supporting the role of blood pressure control in elderly patients with isolated systolic hypertension, and to assess the influence of different drug treatment regimens on outcomes.
Extent of cardiovascular risk reduction associated with treatment of isolated systolic hypertension.
TLDR
Treatment of ISH in older adults results in reduced event rates in 14 years, and treatment before advanced atherosclerosis develops will likely produce the best long-term outcome.
Risk and benefit of treatment of isolated systolic hypertension in the elderly: evidence from the Systolic Hypertension in Europe Trial
TLDR
A meta-analysis partly based on Syst-Eur data showed that in older hypertensive patients pulse pressure and not mean pressure is the major determinant of cardiovascular risk.
Target Blood Pressure for Treatment of Isolated Systolic Hypertension in the Elderly: Valsartan in Elderly Isolated Systolic Hypertension Study
TLDR
Blood pressure targets of <140 mm Hg are safely achievable in relatively healthy patients ≥70 years of age with isolated systolic hypertension, although this trial was underpowered to definitively determine whether strict control was superior to less stringent blood pressure targets.
Pulsatile blood pressure component as predictor of mortality in hypertension: a meta-analysis of clinical trial control groups
TLDR
In hypertensive patients pulse pressure, not mean pressure, is associated with an increased risk of fatal events, and this appears to be true in a broad range of patients with hypertension.
Perspectives on treatment of hypertension in elderly patients
TLDR
It is not appropriate to limit the choice of initial drugs for hypertensive older individuals to a single class of agents, since so many older people have other medical problems that affect this decision and reaching the target blood pressure is the determinant factor for cardiovascular risk reduction.
Principal Results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)
The benefits of lowering a systolic blood pressure below 140 mmHg in elderly hypertension remain controversial. This study is a prospective, randomized, open-label study with blinded assessment of
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References

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Subgroup and per-protocol analysis of the randomized European Trial on Isolated Systolic Hypertension in the Elderly.
TLDR
In elderly patients with isolated systolic hypertension, stepwise antihypertensive drug treatment, starting with the dihydropyridine calcium channel blocker nitrendipine, improves prognosis.
The role of diastolic blood pressure when treating isolated systolic hypertension.
TLDR
It is reassuring that patients receiving treatment for ISH never perform worse than patients receiving placebo in terms of CVD events, and further studies need to determine whether excessively low DBP can be prevented by more careful titration of antihypertensive therapy while maintaining SBP control.
Pulse pressure as a risk factor for cardiovascular events in the MRC Mild Hypertension Trial.
TLDR
Pulse pressure is a strong risk factor for coronary events in untreated hypertensive male subjects in the MRC Mild Hypertension Trial, whereas stroke is best predicted by mean blood pressure.
Pulse Pressure Not Mean Pressure Determines Cardiovascular Risk in Older Hypertensive Patients
TLDR
In older hypertensive patients, pulse pressure not mean pressure is the major determinant of cardiovascular risk, according to a meta-analysis based on individual patient data.
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TLDR
In patients taking active treatment total mortality was increased in the lowest thirds of treated systolic and diastolic blood pressures, suggesting some deterioration of general health.
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TLDR
There is a strong case for treating elderly hypertensives with a diuretic-based regimen, and drugs of both types were well tolerated, in trials representative of unselected patients.
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TLDR
Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes or 59 major cardiovascular endpoints and prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension.
Why is antihypertensive drug therapy needed in elderly patients with systolodiastolic hypertension?
TLDR
A meta-analysis of eight outcome trials of antihypertensive drug treatment in elderly hypertensive patients is presented, and recommendations for the treatment of symptomless patients with isolated systolic hypertension may be premature.
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