ABSTRACT
In a subgroup with diabetes (583 patients out of 4736) in the Systolic Hypertension in the Elderly Program, treatment for 5 years with chlorthalidone and atenolol or reserpine produced an average fall in blood pressure of 9.8/2.2 mmHg relative to placebo.105 This resulted in a significant reductions in major cardiovascular events, nonfatal MI, fatal CHD and major CHD events, with trends towards reductions in both stroke and all-cause mortality. Similar results were seen in the Syst-Eur study, where patients were randomized to placebo or to nitrendipine, with the addition of enalapril or hydrochlorthiazide if targets were not reached. An average fall in blood pressure of 10.1/4.5 mmHg for 2 years resulted in a significant fall in total strokes (relative risk 0.58, CI 0.4-0.83; p 0.003), non-fatal stroke (relative risk 0.56, CI 0.37-0.86; p 0.007), all fatal and non-fatal cardiac endpoints (relative risk 0.74, CI 0.47-0.97; p 0.03) and all fatal and nonfatal cardiovascular endpoints (relative risk 0.69, CI 0.55-0.86; p 0.001).106 In this study, 492 patients (out of 4695) had diabetes and the endpoint reductions were greater in this group than in the study as a whole (stroke risk reduction 0.31, CI 0.11-0.88; p 0.02: all cardiovascular events risk reduction 0.38, CI 0.2-0.81; p 0.002: all cardiac events risk reduction 0.43, CI 0.18-1.06; p 0.06).107
