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From Medscape Cardiology
Hypertension Highlights
Long-term Syst-Eur Data Show Pharmacologic Therapy Works -- As Does Exercise, Penicillin, and Dark Chocolate
Posted 09/12/2003
Introduction
As the major cardiology conference season restarts following the summer, news in hypertension comes from the recent annual congress of the European Society of Cardiology (ESC), held August 30-September 3 in Vienna, Austria. Long-term data from the Systolic Hypertension in Europe (Syst-Eur) trial reported at the congress reinforce the original trial conclusions that blood pressure lowering is safe, well tolerated, and results in clinical benefit in elderly patients with isolated systolic hypertension. A Brazilian study also reported at the Congress appears to have confirmed, using 24-hour blood pressure monitoring, previous reports of hypertension caused by air pollutants. Among the studies in hypertension published over the past month, an association between penicillin, but not other antibiotics, and reduced risk of stroke in elderly hypertensive patients appears to warrant further study. Lifestyle measures against hypertension were the subject of 2 papers, 1 suggesting that not as much exercise as previously thought is needed to lower blood pressure, and another confirming the long-term benefits of weight loss in lowering blood pressure. None of the subjects in either of these studies were receiving antihypertensive medications. Possibly contradicting these measures is more (good?) news about the beneficial effects of chocolate. This time, German researchers report that consumption of dark chocolate reduces blood pressure. However, another study suggests that the effect does not exist if you take milk, or milk chocolate, with it!
Long-term Results of Syst-Eur Confirm Benefits of Original Trial
Extended follow-up data from the Syst-Eur trial confirm the benefit associated with active treatment in elderly patients with isolated systolic hypertension (ISH), Prof. Robert Fagard, MD (Catholic University, Leuven, Belgium), reported at ESC 2003.[1] In the original double-blind Syst-Eur trial (Syst-Eur 1), 4695 ISH patients aged > 60 years were randomized to the calcium channel blocker (CCB) 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.[2] In the extended follow-up study (Syst-Eur 2), patients already on the CCB remained on active treatment, and active treatment was offered to all patients in the placebo group. A total of 3517 patients were followed for an average of 6.28 years. Syst-Eur 2 ended in December 2001.
During Syst-Eur 1, mean SBP fell from 173.8 mm Hg to 151.3 mm Hg in the active treatment group and to 161.7 mm Hg in the placebo group. During extended follow-up, SBP in the active treatment group decreased even further, to 141.3 mm Hg, and in the group that had received placebo and switched to active treatment at the end of Syst-Eur 1, SBP decreased to 142.1 mm Hg. Thus, the original Syst-Eur target SBP of 150 mm Hg was reached in approximately 80% of patients.
In Syst-Eur 1, a highly significant 39% reduction was seen in the incidence of the primary endpoint, fatal and nonfatal stroke, in patients on active treatment. In Syst-Eur 2 the difference was 11%, but over the total follow-up period (Syst-Eur 1 and 2), the difference was again significant at 28% (P = .01). Over the extended follow-up period, stroke rates were similar in the patients who had received placebo since the start of the trial and those who switched to active treatment after the end of the double-blind period. Similar patterns were seen in the incidence of cardiovascular events (sudden death, fatal and nonfatal stroke, myocardial infarction, and heart failure), with significant reductions of 28% during the double-blind period and 15% over the total follow-up period (P = .03).
An important ancillary observation was that the incidence of adverse effects such as cancer, gastrointestinal hemorrhage, and dementia did not differ between the control and active treatment groups in Syst-Eur 1 or Syst-Eur 2. In the opinion of official congress commentator, Frank T Ruschitzka, MD (University Hospital Zurich, Switzerland), these results "will help to put an end to the lengthy discussion" about the safety of long-acting dihydropyridine CCBs
Hypertension Highlights
Long-term Syst-Eur Data Show Pharmacologic Therapy Works -- As Does Exercise, Penicillin, and Dark Chocolate
Posted 09/12/2003
Introduction
As the major cardiology conference season restarts following the summer, news in hypertension comes from the recent annual congress of the European Society of Cardiology (ESC), held August 30-September 3 in Vienna, Austria. Long-term data from the Systolic Hypertension in Europe (Syst-Eur) trial reported at the congress reinforce the original trial conclusions that blood pressure lowering is safe, well tolerated, and results in clinical benefit in elderly patients with isolated systolic hypertension. A Brazilian study also reported at the Congress appears to have confirmed, using 24-hour blood pressure monitoring, previous reports of hypertension caused by air pollutants. Among the studies in hypertension published over the past month, an association between penicillin, but not other antibiotics, and reduced risk of stroke in elderly hypertensive patients appears to warrant further study. Lifestyle measures against hypertension were the subject of 2 papers, 1 suggesting that not as much exercise as previously thought is needed to lower blood pressure, and another confirming the long-term benefits of weight loss in lowering blood pressure. None of the subjects in either of these studies were receiving antihypertensive medications. Possibly contradicting these measures is more (good?) news about the beneficial effects of chocolate. This time, German researchers report that consumption of dark chocolate reduces blood pressure. However, another study suggests that the effect does not exist if you take milk, or milk chocolate, with it!
Long-term Results of Syst-Eur Confirm Benefits of Original Trial
Extended follow-up data from the Syst-Eur trial confirm the benefit associated with active treatment in elderly patients with isolated systolic hypertension (ISH), Prof. Robert Fagard, MD (Catholic University, Leuven, Belgium), reported at ESC 2003.[1] In the original double-blind Syst-Eur trial (Syst-Eur 1), 4695 ISH patients aged > 60 years were randomized to the calcium channel blocker (CCB) 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.[2] In the extended follow-up study (Syst-Eur 2), patients already on the CCB remained on active treatment, and active treatment was offered to all patients in the placebo group. A total of 3517 patients were followed for an average of 6.28 years. Syst-Eur 2 ended in December 2001.
During Syst-Eur 1, mean SBP fell from 173.8 mm Hg to 151.3 mm Hg in the active treatment group and to 161.7 mm Hg in the placebo group. During extended follow-up, SBP in the active treatment group decreased even further, to 141.3 mm Hg, and in the group that had received placebo and switched to active treatment at the end of Syst-Eur 1, SBP decreased to 142.1 mm Hg. Thus, the original Syst-Eur target SBP of 150 mm Hg was reached in approximately 80% of patients.
In Syst-Eur 1, a highly significant 39% reduction was seen in the incidence of the primary endpoint, fatal and nonfatal stroke, in patients on active treatment. In Syst-Eur 2 the difference was 11%, but over the total follow-up period (Syst-Eur 1 and 2), the difference was again significant at 28% (P = .01). Over the extended follow-up period, stroke rates were similar in the patients who had received placebo since the start of the trial and those who switched to active treatment after the end of the double-blind period. Similar patterns were seen in the incidence of cardiovascular events (sudden death, fatal and nonfatal stroke, myocardial infarction, and heart failure), with significant reductions of 28% during the double-blind period and 15% over the total follow-up period (P = .03).
An important ancillary observation was that the incidence of adverse effects such as cancer, gastrointestinal hemorrhage, and dementia did not differ between the control and active treatment groups in Syst-Eur 1 or Syst-Eur 2. In the opinion of official congress commentator, Frank T Ruschitzka, MD (University Hospital Zurich, Switzerland), these results "will help to put an end to the lengthy discussion" about the safety of long-acting dihydropyridine CCBs
