Skip to main content
SpringerLink
Log in

Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: Objectives, protocol, and organization

  • Report on the Syst-Eur Multicentre Trial
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Summary

The Syst-Eur Trial is a concerted action of the European Community’s Medical and Health Research Programme. The trial is carried out in consultation with the World Health Organization, the International Society of Hypertension, the European Society of Hypertension and the World Hypertension League. This article describes the objectives and the protocol of Syst-Eur, a multicentre trial designed by the European Working Party on High Blood. Pressure in the Elderly (EWPHE), to test the hypothesis that antihypertensive treatment of elderly patients with isolated systolic hypertension results in a significant change in stroke morbidity and mortality. Secondary endpoints include cardiovascular events, such as myocardial infarction and congestive heart failure.

To be eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160–219 mmHg with a diastolic pressure less than 95 mmHg. Patients must give their informed consent and be free of major cardiovascular and non-cardiovascular diseases at entry. The patients are randomized to active treatment or placebo. Active treatment consists of nitrendipine (10–40 mg/day), combined with enalapril (5–20 mg/day) and hydrochlorothiazide (12.5–25 mg/day), as necessary. The patients of the control group receive matching placebos. The drugs (or matching placebos) are stepwise titrated and combined in order to reduce systolic blood pressure by 20 mmHg at least to a level below 150 mmHg. Morbidity and mortality are monitored to enable an intention-to-treat and perprotocol comparison of the outcome in the 2 treatment groups.

A one-year pilot trial (1989) showed that the protocol is practicable. The Ethics Committee therefore decided to start the definite study (1990), in which randomized patients will be followed for 5 years. Recruitment of new centres and of the required 3,000 patients will last 3 years (until 1993).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. European Working Party on High Blood Pressure in the Elderly (EWPHE): An international trial of antihypertensive therapy in elderly patients. Objectives, protocol and organization. Arch. Int. Pharmacodyn. Ther. 275: 300–334, 1985.

    Google Scholar 

  2. Amery A., Birkenhäger W., Brixko P., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J., Hamdy R., Henry J.F., Joossens J.V., Leonetti G., Lund-Johansen P., O’Malley K., Petrie J., Strasser T., Tuomilehto J., Williams B.: Mortality and morbidity results from the European Working Party on high blood pressure in the Elderly Trial. Lancet I: 1349–1354, 1985.

    Article  Google Scholar 

  3. Amery A., Birkenhäger W., Brixko P., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F., Forte J., Hamdy R., Henry J.F., Joossens J.V., Leonetti G., Lund-Johansen P., O’Malley K., Petrie J.C., Strasser T., Tuomilehto J., Williams B.: Efficacy of antihypertensive drug treatment according to age, sex, blood pressure and previous cardiovascular disease in patients above the age of 60. Lancet II: 589–592, 1986.

    Article  Google Scholar 

  4. Coope J., Warrender T.S.: Randomized trial of treatment of hypertension in elderly patients in primary care. Br. Med. J. 293: 1145–1151, 1986.

    Article  CAS  Google Scholar 

  5. Kuramoto K., Matsushita S., Kuwajima I., Murakawi M.: Prospective study on the treatment of mild hypertension in the aged. Jpn. Heart J. 22: 75–85, 1981.

    Article  PubMed  CAS  Google Scholar 

  6. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program. II. Mortality by race-sex and age. JAMA 242: 2572–2577, 1979.

    Article  Google Scholar 

  7. Management Committee: Treatment of mild hypertension in the elderly. A study initiated and administered by the National Heart Foundation of Australia. Med. J. Aust. 2: 398–402, 1981.

    Google Scholar 

  8. Staessen J., Fagard R., Van Hoof R., Amery A.: Mortality in various intervention trials in elderly hypertensive patients: a review. Eur. Heart J. 9: 215–222, 1988.

    PubMed  CAS  Google Scholar 

  9. Kannel W.B., Gordon T.: Evaluation of cardiovascular risk in the elderly: the Framingham Study. Bull. N.Y. Acad. Med. 54: 573–591, 1978.

    PubMed  CAS  Google Scholar 

  10. Staessen J., Bulpitt C., Fagard R., Joossens J.V., Lijnen P., Amery A.: Four urinary cations and blood pressure: a population study in two Belgian towns. Am. J. Epidemiol. 117: 676–687, 1983.

    PubMed  CAS  Google Scholar 

  11. M’Buyamba-Kabangu J.R., Fagard R., Lijnen P., Mbuy wa Mbuy R., Staessen J., Amery A.: Blood pressure and urinary cations in urban Bantu of Zaire. Am. J. Epidemiol. 124: 957–968, 1986.

    PubMed  Google Scholar 

  12. Staessen J., Amery A., Fagard R.: Editorial review: isolated systolic hypertension in the elderly. J. Hypertension 8: 393–405, 1990.

    Article  CAS  Google Scholar 

  13. Kannel W.B., Gordon T., Schwartz M.J.: Systolic versus diastolic blood pressure and risk of coronary heart disease. The Framingham Study. Am. J. Cardiol. 27: 335–346, 1971.

    Article  PubMed  CAS  Google Scholar 

  14. Kannel W.B., Dawber T.R., Sorlie P., Wolf P.A.: Components of blood pressure and risk of atherothrombotic brain infarction: the Framingham Study. Stroke 7: 327–331, 1976.

    Article  PubMed  CAS  Google Scholar 

  15. Rabkin S.W., Mathewson F.A., Tate R.B.: Predicting risk of ischemic heart disease and cerebrovascular disease from systolic and diastolic blood pressures. Ann. Intern. Med. 88: 342–345, 1978.

    Article  PubMed  CAS  Google Scholar 

  16. O’Malley K., McCormack P., O’Brien E.T.: Isolated systolic hypertension: data from the European Working Party on High Blood Pressure in the Elderly. J. Hypertension 6 (suppl. 1): S105–S108, 1988.

    Google Scholar 

  17. Menotti A., Seccareccia F., Giampaolo S., Giuli B.: The predictive role of systolic, diastolic and mean blood pressure on cardiovascular and all causes death. J. Hypertension 7: 595–599, 1989.

    Article  CAS  Google Scholar 

  18. Ueda K., Omae T., Hasuo Y., Kiyohara Y.: Impact of high blood pressure on morbidity and mortality. In: Amery A., Staessen J. (Eds.), Handbook of Hypertension. Hypertension in the Elderly, Vol. 12. Elsevier, Amsterdam, 1989, pp. 174–185.

    Google Scholar 

  19. Petrie J.C., O’Brien E.T., Littler W.A., de Swiet M.: Blood pressure measurement. British Medical Journal, London, 1987.

    Google Scholar 

  20. Katz S., Down T.D., Cash H.R., Grotz R.C.: Gerontologist 1: 20–30, 1970.

    Article  Google Scholar 

  21. Keith N.M., Wagener H.P., Barker N.W.: Some different types of essential hypertension: their course and prognosis. Am. J. Med. Sci. 197: 332–343, 1939.

    Article  Google Scholar 

  22. Pipberger H.V., Artsbaecher R.E., Berson A.S.: Recommendations for standardization of leads and of specifications for instruments in electrocardiography and vectorcardiography. American Heart Association Committee on Electrocardiography. Circulation 52: 11–31, 1975.

    Google Scholar 

  23. World Health Organization: Arterial Hypertension. Report of a WHO Expert Committee. World Health Organization Technical Report Series 628, Geneva, 1978.

  24. Kendall M.J., Lobo J., Jack D.B., Main A.N.H.: The influence of age on the pharmacokinetics of nitrendipine. J. Cardiovasc. Pharmacol. 9 (Suppl. 4): S96–S100, 1987.

    Article  Google Scholar 

  25. Lettieri J., Krol G., Yeh S., Ryan J., Jain A., McMahon F.G., Burkholder D., Birkett J.P.: Pharmacokinetics of nitrenidipine in elderly and young healthy volunteers. J. Cardiovasc. Pharmacol. 9 (Suppl. 4): S142–S147, 1987.

    Article  Google Scholar 

  26. Ferreira-Filho S.R., Saragoça M.A., Oliveira P.C., Moriguti J., Ajzen H., Ramos O.L.: Use of nitrendipine in the treatment of systolic hypertension in elderly patients. J. Cardiovasc. Pharmacol. 9 (Suppl. 4): S218–S220, 1987.

    Google Scholar 

  27. Borzellino M., Homes G., Finizola A., Graterol S., Kobelt R., Rojas Z., Rodriguez I.E., Rodriguez E., Finizola B.: Nitrendipine in elderly hypertensives. J. Cardiovasc. Pharmacol. 9 (Suppl 4): S290–S294, 1987.

    Google Scholar 

  28. Hulthén U.L., Katzman P.L.: Review of long-term trials with nitrendipine. J. Cardiovasc. Pharmacol. 12 (Suppl. 4): S11–S15, 1988.

    Article  PubMed  Google Scholar 

  29. Davies R.O., Irvin J.D., Kramsch D.K., Walker J.F., Moncloa F.: Enalapril worldwide experience. Am. J. Med. 77: 23–35, 1984.

    Article  PubMed  CAS  Google Scholar 

  30. Moncloa F., Sromovsky J.A., Walker J.F., Davies R.O.: Enalapril in hypertension and congestive heart failure. Overall review of efficacy and safety. Drugs 30 (Suppl. 1): 82–89, 1985.

    Article  PubMed  Google Scholar 

  31. Lees K.R., Reid J.L.: Age and the pharmacokinetics and pharmacodynamics of chronic enalapril treatment. Clin. Pharmacol. Ther. 41: 597–602, 1987.

    Article  PubMed  CAS  Google Scholar 

  32. Conway J., Lauwers P.: Hemodynamic and hypotensive effects of long-term therapy with chlorothiazide. Circulation 21: 21–27, 1960.

    Article  PubMed  CAS  Google Scholar 

  33. Wikstrand J., Westergren G., Berglund G., Bracchetti D., Van Couter A., Feldstein C.A., Ming K.S., Kuramoto K., Landahl S., Meaney E., Pedersen E.B., Rahn K.H., Shaw J., Smith A., Waal-Manning H.: Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. JAMA 255: 1304–1310, 1986.

    Article  PubMed  CAS  Google Scholar 

  34. World Health Organization: International Classification of Diseases, 1975 Revision. Vol. 1, Geneva 1978.

  35. Aho K., Harmsen P., Hatano S., Marquardsen J., Smirnov V.E.: Cerebrovascular disease in the community: results of a WHO collaborative study. Bull. WHO 58: 113–130, 1980.

    PubMed  CAS  Google Scholar 

  36. Genton E., Barnett H.J.M., Fields W.S., et al.: Cerebral ischemia: the role of thrombosis and antithrombotic therapy. Joint Committee for Stroke Resources. Stroke 8: 147, 1977.

    Article  Google Scholar 

  37. Heyman A., Leviton A., Millikan C.H., Nefzger M.D., Ostfeld A.M., Sahs A.L., Stallones A.R., Whisnant J.P.: Transient focal cerebral ischemia: epidemiological and clinical aspects. Stroke 5: 277–287, 1977.

    Google Scholar 

  38. Rose G.A., Blackburn H.: Méthodes d’enquête sur les maladies cardio-vasculaires. Organisation mondiale de la Santé. Genève, 1969.

  39. Pocock S.J.: Group sequential methods in the design and analysis of clinical trials. Biometrika 64: 191–199, 1977.

    Article  Google Scholar 

  40. O’Brien P.C., Fleming T.R.: A multiple testing procedure for clinical trials. Biometrics 35: 549–556, 1979.

    Article  PubMed  Google Scholar 

  41. Staessen J., Fagard R., Lijnen P., Van Hoof R., Amery A.: Review of the major intervention trials in the elderly. Cardiovasc. Drugs Ther. 4: 1237–1242, 1990.

    Article  Google Scholar 

  42. Kannel W.B., Dawber T.R., McGee D.L.: Perspectives on systolic hypertension: the Framingham Study. Circulation 61: 1179–1182, 1980.

    Article  PubMed  CAS  Google Scholar 

  43. Kannel W.B., Wolf P.A., McGee D.L., Dawber T.R., McNamara P., Castelli W.P.: Systolic pressure, arterial rigidity, and risk of stroke. JAMA 245: 1225–1229, 1981.

    Article  PubMed  CAS  Google Scholar 

  44. Garland C., Barret-Connor E., Suarez L., Criqui M.H.: Isolated systolic hypertension and mortality after age 60 years: a prospective population-based study. Am. J. Epidemiol. 118: 365–376, 1983.

    PubMed  CAS  Google Scholar 

  45. Colandrea M.A., Friedman G.D., Nichaman M.Z., Lynd C.N.: Systolic hypertension in the elderly. An epidemiologic assessment. Circulation 41: 239–245, 1970.

    Article  PubMed  CAS  Google Scholar 

  46. Dyer A.R., Stamler J., Shekelle R.B., Schoenberger J.A., Farinaro E.: Hypertension in the elderly. Med. Clin. North Am. 61: 513–529, 1977.

    PubMed  CAS  Google Scholar 

  47. Curb D.J., Borhani N.O., Entwisle G., Tung B., Kass E., Schnaper H., Williams W., Berman: Isolated systolic hypertension in 14 communities. Am. J. Epidemiol. 121: 362–370, 1985.

    Article  PubMed  CAS  Google Scholar 

  48. McClellan W., Hall W.D., Brogan D., Martinez B., Wilber J.A.: Isolated systolic hypertension: declining prevalence in the elderly. Prev. Med. 16: 686–695, 1987.

    Article  PubMed  CAS  Google Scholar 

  49. Rutan G.H., Kuller L.H., Neaton J.D., Wentworth D.N., McDonald R.H., McFate Smith W.: Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. Circulation 77: 504–514, 1988.

    Article  PubMed  CAS  Google Scholar 

  50. Vogt T.M., Curtis Ireland C., Black D., Camel G., Hughes G.: Recruitment of elderly volunteers for a multicenter clinical trial: the SHEP pilot study. Controlled Clin. Trials 7: 118–133, 1986.

    Article  PubMed  CAS  Google Scholar 

  51. Wing S., Aubert R.E., Hansen J.P., Harnes C.G., Slome C., Tyroler H.A.: Isolated systolic hypertension in Evans county. I. Prevalence and screening considerations. J. Chronic Dis. 35: 735–742, 1982.

    Article  PubMed  CAS  Google Scholar 

  52. Kannel W.B., Wolf P.A., McGee D.L., Dawber T.R., McNamara P., Castelli W.P.: Systolic blood pressure, arterial rigidity, and risk of stroke. JAMA 245: 1225–1229, 1981.

    Article  PubMed  CAS  Google Scholar 

  53. Wilking S.V.B., Belanger A., Kannel W.B., D’Agostino R.B., Steel K.: Determinants of isolated systolic hypertension. JAMA 260: 3451–3455, 1988.

    Article  PubMed  CAS  Google Scholar 

  54. The WHO/ISH (International Society of Hypertension) Mild Hypertension Liaison Committee: 1989 Guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. Bull. WHO 67: 493–498, 1989.

    Google Scholar 

  55. Davies B.R., Ford C.E., Remington R.D., Stamler R., Hawkins C.M.: The Hypertension Detection and Follow-up Program design: methods, and baseline characteristics and blood pressure response of the study population. Prog. Cardiovasc. Dis. 29 (Suppl. 1): 11–28, 1986.

    Article  Google Scholar 

  56. Folstein M.F., Folstein S.E., McHugh R.P.: “Mini Mental State”. A practical method for grading the cognitive function state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.

    Article  PubMed  CAS  Google Scholar 

  57. Applegate W., Dismuke E., Runyan J.W. Jr: Treatment of hypertension in the elderly: a time of caution? J. Am. Geriatr. Soc. 32: 21–23, 1984.

    PubMed  CAS  Google Scholar 

  58. The Working Group on Hypertension in the Elderly: Statement on hypertension in the elderly. JAMA 256: 70–74, 1986.

    Article  Google Scholar 

  59. Gifford R.W. Jr: Geriatric hypertension: Chairman’s comments on the NIH Working Group report. Geriatrics 42: 45–50, 1987.

    PubMed  Google Scholar 

  60. The Joint National Committee: The 1988 report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure. Arch. Intern. Med. 148: 1023–1038, 1988.

    Article  Google Scholar 

  61. McFate-Smith W.: The case for treating hypertension in the elderly. Am. J. Hypertens. 1 (Suppl. 1): 173s–178s, 1988.

    Article  Google Scholar 

  62. Saltzberg S., Stroh J.A., Frishman W.H.: Isolated systolic hypertension in the elderly: pathophysiology and treatment. Med. Clin. North Am. 72: 523–547, 1988.

    PubMed  CAS  Google Scholar 

  63. Breckenridge M.B., Kostis J.B.: Isolated systolic hypertension in the elderly: results of a statewide survey of clinical practice in New Jersey. Am. J. Med. 86: 370–375, 1989.

    Article  PubMed  CAS  Google Scholar 

  64. Schnall C., Weiner J.S.: Clinical evaluation of blood pressure in alcoholics. Q. J. Stud. Alcohol 19: 432–446, 1958.

    PubMed  CAS  Google Scholar 

  65. deVries H.A.: Physiological effects of an exercise training regimen upon men aged 52 to 88. J. Gerontol. 25: 325–336, 1970.

    Article  PubMed  Google Scholar 

  66. Weber F., Banard R.J., Roy D.: Effects of a high-complex-carbohydrate, low-fat diet and daily exercise on individuals 70 years of age and older. J. Gerontol. 38: 155–161, 1983.

    Article  PubMed  CAS  Google Scholar 

  67. Niarchos A.P., Weinstein D.L., Laragh J.H.: Comparison of the effects of diuretic therapy and low sodium intake in isolated systolic hypertension. Am. J. Med. 77: 1061–1068, 1984.

    Article  PubMed  CAS  Google Scholar 

  68. Seals D.R., Hurley B.F., Hagberg J.M., Schultz J., Linder B.J., Natter L., Ehsani A.A.: Effects of training on systolic time intervals at rest and during isometric exercise in men and women 61 to 64 years old. Am. J. Cardiol. 55: 797–800, 1985.

    Article  PubMed  CAS  Google Scholar 

  69. Posner J.D., Gorman K.M., Klein H.S., Woldow A.: Exercise capacity in the elderly. Am. J. Cardiol. 57: 52C-58C, 1986.

    Article  Google Scholar 

  70. Cunningham D.A., Rechnitzer P.A., Howard J.H., Donner A.P.: Exercise training of men at retirement: a clinical trial. J. Gerontol. 42: 17–23, 1987.

    Article  PubMed  CAS  Google Scholar 

  71. Potter J.F., Beevers G.D.: Non-pharmacological reduction of blood pressure in the elderly. In: Amery A., Staessen J. (Eds.), Handbook of Hypertension. Hypertension in the Elderly, Vol. 12. Elsevier, Amsterdam, 1989, pp. 352–367.

    Google Scholar 

  72. Mattila K., Haavisto M., Rajala S., Heikinheimo R.: Blood pressure and five-year survival in the very old. Br. Med. J. 296: 887–889, 1988.

    Article  CAS  Google Scholar 

  73. Staessen J., Bulpitt C., De Leeuw P., Fagard R., Fletcher A., Fqrette F., Leonetti G., Nissinen A., O’Malley K., Tuomilehto J., Webster J., Williams B.O.: Relation between mortality and treated blood pressure in elderly patients with hypertension: report from the European Working Party on High Blood Pressure in the Elderly. Br. Med. J. 298: 1552–1556, 1989.

    Article  CAS  Google Scholar 

  74. Forette B., Tortrat D., Wolmark Y.: Cholesterol as risk factor for mortality in elderly women. Lancet I: 868–870, 1989.

    Article  Google Scholar 

  75. Staessen J., Amery A., Birkenhäger W., Bulpitt C., Clement D., de Leeuw P., De Schaepdryver A., Dollery C., Fagard R., Fletcher A., Forette F., Forte J., Henry J.F., Koistinen A., Leonetti G., Nissinen A., O’Brien E., O’Malley K., Pelemans W., Petrie J.C., Strasser T., Terzoli L., Thijs L., Tuomilehto J., Webster J., Williams B.: Is a high serum cholesterol level associated with longer survival in elderly hypertensives? J. Hypertension 8: 755–761, 1990.

    Article  CAS  Google Scholar 

  76. Levenson J., Simon A., Maarek B., Totomoukouo J., Gitelman R., Bouthier J., Safar M.: Comparative effects of beta-adrenergic blockade in systolic hypertension according to age. Eur. Heart J. 4 (Suppl. G): 51–54, 1983.

    Article  PubMed  Google Scholar 

  77. Vardan S., Mookherjee S., Warner R., Smulyan H.: Systolic hypertension in the elderly. Hemodynamic response to long-term thiazide diuretic therapy and its side effects. JAMA 250: 2807–2813, 1983.

    Article  PubMed  CAS  Google Scholar 

  78. Gray D.R., Weber M.A., Drayer J.I.M.: Effects of low-dose antihypertensive therapy in elderly patients with predominant systolic hypertension. J. Gerontol. 38: 302–306, 1983.

    Article  PubMed  CAS  Google Scholar 

  79. Boyles P.W.: Hydrochlorothiazide plus methyldopa in the treatment of isolated systolic hypertension in the elderly. Clin. Ther, 6: 793–799, 1984.

    PubMed  CAS  Google Scholar 

  80. Niarchos A.P., Laragh J.H.: Effects of diuretic therapy in low-normal- and high-renin isolated systolic systemic hypertension. Am. J. Cardiol. 53: 797–801, 1984.

    Article  PubMed  CAS  Google Scholar 

  81. Vaicaitis J.S.: Methyldopa: an agent for the treatment of older patients with isolated systolic hypertension. Clin. Ther. 6: 451–456, 1984.

    PubMed  CAS  Google Scholar 

  82. Hulley S.B., Furberg C.D., Gurland B., McDonald R., Perry H.M., Schnaper H.W., Schoenberger J.A., McFate Smith W., Vogt T.M.: Systolic hypertension in the elderly program (SHEP): antihypertensive efficacy of chlorthalidone. Am, J. Cardiol. 56: 913–920, 1985.

    Article  CAS  Google Scholar 

  83. Morledge J.H., Ettinger B., Aranda J., McBarron F., Barra P., Gorwit J., Davidov M.: Isolated systolic hypertension in the elderly. A placebo-controlled, dose-response evaluation of chlorthalidone. J. Am. Geriatr. Soc. 34: 199–206, 1986.

    PubMed  CAS  Google Scholar 

  84. McFate Smith W., Feigal D.W., Furberg C.D., Greenlick M., Kuller L., Perry H.M., Schnaper H.W., Schoenberger J.A.: Use of diuretics in treatment of hypertension in the elderly. Drugs 31 (Suppl. 4): 154–164, 1986.

    Google Scholar 

  85. Shapiro DA, Liss C.L., Walker J.F., Lewis J.L., Lengerich R.A., Irvin J.D.: Enalapril and hydrochlorothiazide as antihypertensive agents in the elderly. J. Cardiovasc. Pharmacol. 10 (Suppl. 7): 5160–162, 1987.

    Google Scholar 

  86. Duchier J., Iannascoli F., Safar M.: Antihypertensive effect of sustained-release isosorbide dinitrate for isolated systolic systemic hypertension in the elderly. Am. J. Cardiol. 60: 99–102, 1987.

    Article  PubMed  CAS  Google Scholar 

  87. O’Malley K., McCormack P., O’Brien E.T.: Isolated systolic hypertension: data from the European Working Party on High Blood Pressure in the Elderly. J. Hypertension 6 (Suppl. 1):S105–S108, 1988.

    Google Scholar 

  88. Murray G.D., Lesaffre E.: Statistical pitfalls in the analysis of age-related effects in antihypertensive therapy: J. Cardiovasc. Pharmacol. 12 (Suppl. 8): S167–S172, 1988.

    PubMed  Google Scholar 

  89. Thijs L., Amery A., Birkenhäger W., Bulpitt C.J., Clement D., Dall J., De Leeuw P., De Schaepdryver A., Dollery C., Forette F., Henry J.F., Koistinen A., Leonetti G., Nissinen A., O’Brien E., O’Malley K., Staessen J., Strasser T., Terzoli L., Tuomilehto J., Webster J., Williams B.O., Zanchetti A.: Age-related effects of placebo and active treatment in patients beyond the age of 60 years: the need of a proper control group. J. Hypertension 8: 997–1002, 1990.

    Article  CAS  Google Scholar 

  90. Buhler F.R.: Age and pathophysiology-oriented antihypertensive response to calcium antagonists. J. Cardiovasc. Pharmacol. 12 (Suppl. 8): S156–S162, 1988.

    PubMed  Google Scholar 

  91. Levenson J.A., Safar M.E., Simon A.C., Bouthier J.A., Griener L.: Central and arterial hemodynamic effects of nifedipine (20 mg) in mild to moderate hypertension. Hypertension 5 (Suppl. V): V57–V60, 1983.

    PubMed  CAS  Google Scholar 

  92. Safar M.E., Simon A.C., Levenson J.A., Cazor J.L.: Hemodynamic effects of diltiazem in hypertension. Circ. Res. 52 (Suppl. 1): 169–173, 1983.

    Google Scholar 

  93. Kohno M., Kumada T., Ozaki M.: Evaluation of aortic wall distensibility by aortic pressure-diameter relation: effects of nifedipine on aortic wall. Cardiovasc. Res. 21: 305–312, 1987.

    Article  PubMed  CAS  Google Scholar 

  94. Simon A.C., Levenson J.A., Bouthier J.A.: Comparison of oral MK 412 and propranolol in mild to moderate essential hypertension and their effects on arterial and venous vessels of the forearm. Am. J. Cardiol. 53: 781–785, 1984.

    Article  PubMed  CAS  Google Scholar 

  95. Safar M.E., Laurent S., Bouthier J.A., London G.M.: Comparative effects of captopril and isosorbide dinitrate on the arterial wall of hypertensive human brachial arteries. J. Cardiovasc. Pharmacol. 8: 1257–1261, 1986.

    Article  PubMed  CAS  Google Scholar 

  96. Levy B.I., Michel J.B., Salzmann J.L., Azizi M., Poitevin P., Safar M., Camilleri J.P.: Effects of chronic inhibition of converting enzyme on mechanical and structural properties of arteries in rat renovascular hypertension. Circ. Res. 63: 227–239, 1988.

    Article  PubMed  CAS  Google Scholar 

  97. Safar M.E.: Editorial review. Pulse pressure in essential hypertension: clinical and therapeutical implications. J. Hypertension 7: 769–776, 1989.

    Article  CAS  Google Scholar 

  98. Staessen J., Cattaert A., Fagard R., Lijnen P., Vanhees L., Amery A.: Epidemiology of treated, compared to untreated hypertension. In: Genest J., Kuchel O., Hamet P., Cantin M. (Eds.), Hypertension. McGraw-Hill Book Company, New York, 1983, pp. 1069–1093.

    Google Scholar 

  99. Fletcher A., Amery A., Birkenhager W., Bulpitt C., Clement D., De Leeuw P., Deruyttere M., De Schaepdryver A., Dollery C., Fagard Lund-Johansen P., Nissinen A., O’Brien E., O’Malley K., Pelemans W., Petrie J.C., Staessen J., Strasser T., Terzoli L., Thijs L., Tuomilehto J., Webster J., Williams B.O.: Risks and benefits in the European Working Party on High Blood Pressure in the Elderly Trial. J. Hypertension 9: 225–230, 1990.

    Article  Google Scholar 

  100. Vogt T.M., Curtis Ireland C., Black D., Camel G., Hughes G.: Recruitment of elderly volunteers for a multicenter clinical trial: the SHEP pilot study. Controlled Clin. Trials 7: 118–133, 1986.

    Article  PubMed  CAS  Google Scholar 

  101. Black D.M., Brand R.J., Greenlick M., Hughes G., Smith J., for the SHEP Pilot Research Group: Compliance to treatment for hypertension in elderly patients: the SHEP Pilot Study. J. Gerontol. 42: 552–557, 1987.

    Article  PubMed  CAS  Google Scholar 

  102. Perry Jr. H.M., McDonald R.H., Hulley S.B., McFate-Smith W., Furberg C.D., Greenlick M.R., Kuller L.H., Schnaper H.W., Schoenberger J.A., Vogt T.M.: Systolic Hypertension in the Elderly Program, Pilot Study (SHEP-PS). J. Hypertension 4 (Suppl. 6): S21–S23, 1986.

    Google Scholar 

  103. Furberg C.D., Black D.M., for the SHEP Research Group: The systolic hypertension in the elderly pilot program: methodological issues. Eur. Heart J. 9: 223–227, 1988.

    PubMed  CAS  Google Scholar 

  104. Perry H.M., Smith W.M., McDonald R.H., Black D., Cutler J.A., Furberg C.D., Greenlick M.R., Kuller L.H., Schnaper H.W., Schoenberger J.A., Vogt T.M., Wolf P.A., Hulley S.B.: Morbidity and mortality in the Systolic Hypertension in the Elderly Program (SHEP) Pilot Study. Stroke 20: 4–13, 1989.

    Article  PubMed  Google Scholar 

  105. Miall W.E., Greenberg G.: Mild hypertension: is there pressure to treat? Cambridge University Press, Cambridge 1987, pp. 153–178.

    Google Scholar 

  106. Dahlöf B., Hansson L., Lindholm L., Schersten B., Wester P.O.: STOP-Hypertension — Preliminary communication from the Pilot Study of the Swedish Trial in Old Patients with Hypertension. J. Hypertension 5 (Suppl. 5): S607–S610, 1987.

    Google Scholar 

  107. Wu Y.K., Lu C.Q., Gao R.C., Yu J.S., Liu G.C.: Nation-wide hypertension screening in China during 1979–1980. Chin. Med. J. 95: 101–108, 1982.

    PubMed  CAS  Google Scholar 

  108. Tao S.C., Zhang X.G., Wang S.Y., Yu X.H., Wu X., Lu C.Q.: Incidence of acute myocardial infarction and stroke in the capital iron and steel region of Beijing, China. Magnesium 1: 144–150, 1982.

    Google Scholar 

  109. Wu Z.S., Hong Z.G., Yao C.H., Chen D.Y., Nan L., Min Z., Wu Y.Y., Wu Y.K.: Sino-Monica-Beijing Study: report of the results between 1983–1985. Chin. Med. J. 100: 611–620, 1987.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Syst-Eur Coordinating Office, Laboratorium Hypertensie, Campus Gasthuisberg, Gebouw Onderwijs en Navorsing, Herestraat 49, B-3000, Leuven, Belgium

    J. Staessen M.D., Ph.D.

Authors
  1. A. Amery
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Birkenhäger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. J. Bulpitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Clément
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. De Leeuw
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. T. Dollery
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Fagard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. Forette
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Leonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E. T. O’Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. K. O’Malley
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J. L. Rodicio
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J. Rosenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. J. Staessen M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. T. Strasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. L. Terzoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. L. Thijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. J. Tuomilehto
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. J. Webster
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Amery, A., Birkenhäger, W., Bulpitt, C.J. et al. Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: Objectives, protocol, and organization. Aging Clin Exp Res 3, 287–302 (1991). https://doi.org/10.1007/BF03324024

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324024

Keywords

Search

Navigation