Further learnings from the European Working Party on High Blood Pressure in the Elderly (EWPHE) study: focus on systolic hypertension.

Event rates in relation to the number of elderly hypertensives treated were calculated from randomized analysis data from the 840 patients who completed the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial. In all, the actively treated group had 29 fewer cardiovascular events per 1000 patient years. Putting this another way, treating 34 patients for 1 year would prevent one cardiovascular event. Moreover, as there were 14 fewer cardiovascular deaths and 11 fewer nonfatal strokes per 1000 patient years in the actively treated groups, we calculated that treating 71 or 91 elderly patients for 1 year would prevent one cardiovascular death or nonfatal stroke, respectively. Because of the higher baseline incidence of cardiovascular events in this study, there were greater gains in terms of absolute reductions in mortality and morbidity in treated elderly hypertensive patients than in younger patients in similar studies. Of the 840 patients who participated in the trial, 247 had systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than or equal to 95 mmHg. In this group, blood pressure was reduced by 13/8 mmHg after 3 years in those randomized to active treatment compared to placebo. While patient numbers were insufficient to draw firm conclusions, their outcome on treatment was similar to that for patients on active treatment in the overall study. These results high-light the need for a rigorous assessment of the value of treating isolated systolic hypertension in the elderly.

RCT Entities:   Population Interventions Outcomes