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Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension

Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension,Jan A Staessen,Robert Fagard

Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension   (Citations: 698)
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Summary Background Isolated systolic hypertension occurs in about 15% of people aged 60 years or older. In 1989, the European Working Party on High Blood Pressure in the Elderly investigated whether active treatment could reduce cardiovascular complications of isolated systolic hypertension. Fatal and non-fatal stroke combined was the primary endpoint. Methods All patients (˜60 years) were initially started on masked placebo. At three run-in visits 1 month apart, their average sitting systolic blood pressure was 160-219 mm Hg with a diastolic blood pressure lower than 95 mm Hg. After stratification for centre, sex, and previous cardiovascular complications, 4695 patients were randomly assigned to nitrendipine 10-40 mg daily, with the possible addition of enalapril 5-20 mg daily and hydrochlorothiazide 12·5-25·0 mg daily, or matching placebos. Patients withdrawing from double-blind treatment were still followed up. We compared occurrence of major endpoints by intention to treat. Findings At a median of 2 years' follow-up, sitting systolic and diastolic blood pressures had fallen by 13 mm Hg and 2 mm Hg in the placebo group (n=2297) and by 23 mm Hg and 7 mm Hg in the active treatment group (n=2398). The between-group differences were systolic 10·1 mm Hg
Published in 1997.
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