Syst-Eur TRIAL

Problem Isolated systolic hypertension
Format Double-blinded multi-center RCT
Treatment Nitrendipine (+- enalapril +- hydrochlorothiazide)
Control Placebo
Population 4695
Inclusion criteria Aged > 60
BP > 160 / 95
Exclusion criteria Systolic hypertension secondary to a disorder needing specific medical or surgical treatment
Retinal haemorrhage or papilloedema
Congestive heart failure
Dissecting aortic aneurysm
Serum creatinine concentration at presentation of 180 mol/L or more
History of severe nose bleeds, stroke, or myocardial infarction in the year
before the study
Substance abuse
Any disorder prohibiting a sitting or standing position
Any severe concomitant cardiovascular or non-cardiovascular disease.
Follow-up Median 2 years
Primary endpoint Fatal and nonfatal stroke
Secondary endpoint(s) Death
Retinal haemorrhage or exudates
Myocardial infarction
Congestive heart failure
Dissecting aortic aneurysm
Renal insufficiency.
Details .
Brief summary: Treatment initially with nitrendipine reduces stroke & CV events; ABPM better predictor of morbidity/mortality
PAPER: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.
Date 13 Sep 1997
Journal Lancet. 1997 Sep 13;350(9080):757-64.
Information For active treatment:
-43.5% achieve target BP (21.4% for placebo) at median follow-up
-Active treatment reduced all strokes by 42%
-All fatal and nonfatal cardiac endpoints, including sudden death, decreased by 26%
-The incidence of TIA was not significantly influenced
PAPER: Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators.
Date 11 Aug 1999
Journal JAMA. 1999 Aug 11;282(6):539-46.
Information Subgroup analysis comparing conventional and ambulatory BP measurement in elderly
-Abulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP