The Syst-Eur trial investigated whether active treatment starting with the
dihydropyridine calcium channel blocker (CCB) nitrendipine, could reduce th
e cardiovascular complications of isolated systolic hypertension (ISH) in t
he elderly. The intention-to-treat analysis showed that active treatment im
proved outcome. The per-protocol analysis largely confirmed these results.
The effect of treatment on total and cardiovascular mortality might be atte
nuated in very old patients. Further analysis also suggested benefit in tho
se patients who remained on nitrendipine monotherapy. Active treatment was
more beneficial in patients with diabetes as compared with those without di
abetes at entry and reduced the incidence of dementia by 50%. Analyses of d
ata from the Ambulatory Blood Pressure Monitoring (ABPM) Side Project sugge
sted that most of the benefit of treatment was seen in patients with a dayt
ime systolic BP greater than or equal to 160 mm Hg. Finally, a meta-analysi
s partly based on Syst-Eur data showed that in older hypertensive patients
pulse pressure and not mean pressure is the major determinant of cardiovasc
ular risk. (C) 2001 Lippincott Williams & Wilkins, Inc.