ABSTRACT
Meta-analyses (1-4) of trials performed in mostly systolicdiastolic hypertension and in elderly individuals with isolated systolic hypertension have concluded that antihypertensive treatment results in significant and similar reductions of cardiovascular and all-cause mortality in both types of hypertension. In mainly younger subjects with diastolic hypertension, Collins et al. (5) observed a significant reduction in fatal stroke (45%; P 0.001), but not in fatal coronary heart disease (11%; NS). This discrepancy might be related to age, because coronary mortality was reduced by 26% (P 0.01) in elderly individuals with systolic-diastolic hypertension (6). Fatal and non-fatal strokes combined and all coronary events were significantly reduced in both types of hypertension. The Blood Pressure Lowering Treatment Trialists Collaboration (BPLTTC) (7) performed separate meta-analyses of placebo-controlled trials in which active treatment was initiated by a calcium antagonist or by an angiotensin-converting enzyme (ACE) inhibitor, and showed the reductions in cardiovascular endpoints were similar to those found in the trials in which active treatment was based on diuretics or beta-blockers.
