Document Detail


Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators.
MedLine Citation:
PMID:  10450715     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: The clinical use of ambulatory blood pressure (BP) monitoring requires further validation in prospective outcome studies. OBJECTIVE: To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension. DESIGN: Substudy to the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial, started in October 1988 with follow up to February 1999. The conventional BP at randomization was the mean of 6 readings (2 measurements in the sitting position at 3 visits 1 month apart). The baseline ambulatory BP was recorded with a noninvasive intermittent technique. SETTING: Family practices and outpatient clinics at primary and secondary referral hospitals. PARTICIPANTS: A total of 808 older (aged > or =60 years) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic. INTERVENTIONS: For the overall study, patients were randomized to nitrendipine (n = 415; 10-40 mg/d) with the possible addition of enalapril (5-20 mg/d) and/or hydrochlorothiazide (12.5-25.0 mg/d) or to matching placebos (n = 393). MAIN OUTCOME MEASURES: Total and cardiovascular mortality, all cardiovascular end points, fatal and nonfatal stroke, and fatal and nonfatal cardiac end points. RESULTS: After adjusting for sex, age, previous cardiovascular complications, smoking, and residence in western Europe, a 10-mm Hg higher conventional systolic BP at randomization was not associated with a worse prognosis, whereas in the placebo group, a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate (HR) of most outcome measures (eg, HR, 1.23 [95% confidence interval [CI], 1.00-1.50] for total mortality and 1.34 [95% CI, 1.03-1.75] for cardiovascular mortality). In the placebo group, the nighttime systolic BP (12 AM-6 AM) more accurately predicted end points than the daytime level. Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP (10% increase in night-to-day ratio; HR for all cardiovascular end points, 1.41; 95% CI, 1.03-1.94). At randomization, the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg (95% CI, 128-156 mm Hg), 145 mm Hg (95% CI, 126-164 mm Hg) or 132 mm Hg (95% CI, 120-145 mm Hg), respectively. In the active treatment group, systolic BP at randomization did not significantly predict cardiovascular risk, regardless of the technique of BP measurement. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP.
Authors:
J A Staessen; L Thijs; R Fagard; E T O'Brien; D Clement; P W de Leeuw; G Mancia; C Nachev; P Palatini; G Parati; J Tuomilehto; J Webster
Related Documents :
9331015 - The efficacy and tolerability of candesartan cilexetil in an elderly hypertensive popul...
2455155 - Slow-release metoprolol and nifedipine in essential hypertension: 24 hour noninvasive a...
1282585 - Arterial and antihypertensive effects of nitrendipine: a double-blind comparison versus...
19142365 - Analysis of the prescription of captopril to hospitalized patients.
6725085 - Unilateral acute lung injury induced by ethchlorvynol in anesthetized dogs.
25106745 - Comprehensive study of hydrostatic pressure treated human umbilical cord blood cells vi...
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  282     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-08-19     Completed Date:  1999-08-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  539-46     Citation Subset:  AIM; IM    
Affiliation:
Department of Molecular and Cardiovascular Research, University of Louvain, Leuven, Belgium. jan.staessen@med.kuleuven.ac.be
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / therapeutic use
Blood Pressure Determination / methods*
Blood Pressure Monitoring, Ambulatory
Cardiovascular Diseases / epidemiology*
Female
Humans
Hypertension / complications,  diagnosis,  drug therapy,  physiopathology*
Male
Middle Aged
Prognosis
Randomized Controlled Trials as Topic
Reproducibility of Results
Risk Factors
Systole
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
JAMA. 2000 Jan 26;283(4):475-6   [PMID:  10659866 ]
JAMA. 2000 Jan 26;283(4):475; author reply 476   [PMID:  10659865 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Trends in perinatal transmission of HIV/AIDS in the United States.
Next Document:  Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-...