Abstract
For hypertensive patients, it has been recommended that antihypertensive treatment strategies be chosen on the basis of the patients' conditions and age. In this sub-analysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial, we aimed to compare the effects of candesartan and amlodipine on cardiovascular mortality and morbidity in Japanese elderly patients with high-risk hypertension and to determine their optimal target blood pressures (BPs). The effect of the two drugs on cardiovascular events was compared across different age subgroups (<65, 65–74, and 75–84 years) by use of Cox regression analysis. We also evaluated the associations between the achieved BP and the incidence of cardiovascular events, irrespective of the allocated drugs in multiple Cox regression analyses. The incidence of cardiovascular events was independent of the assigned treatment for each of the age subgroups. For systolic BP (SBP), cardiovascular risk increased steeply when control of SBP was inadequate (higher than 140 mmHg) for patients younger than 65 years old and those between 65 and 74 years old. Patients aged 75 to 84 years old showed a significantly increased risk when their SBP was ≥150 mmHg. For diastolic BP (DBP), the risk significantly increased for the subgroup aged 75 to 84 years when the DBP was ≥85 mmHg. The present results show that candesartan and amlodipine are equally effective in Japanese elderly patients with highrisk hypertension. Moreover, it is important to control BP levels to less than 150/85 mmHg for patients 75–84 years old.
References
SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final Results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–3264.
Staessen JA, Fagard R, Thijs L, et al, Systolic Hypertension in Europe (Syst-Eur) Trial Investigators: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 35: 757–764.
Liu L, Wang JG, Lui G, Staessen JA : Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens 1998; 16: 1823–1829.
Gong L, Zhang W, Zhu Y, et al: Shanghai trial of nifedipine in the elderly (STONE). J Hypertens 1996; 14: 1237–1245.
Lithell H, Hansson L, Skoog I, et al, SCOPE Study Group: The study on cognition and prognosis in the elderly (SCOPE) principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–886.
Kjeldsen SE, Dahlöf B, Devereux RB, et al, LIFE (Losartan Intervention for Endpoint Reduction) Study Group: Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy. JAMA 2002; 288: 1491–1498.
Ogihara T, Nakao K, Fukui T, et al, CASE-J Trial Group: Effects of candesartan compared with amlodipine in hypertensive patients with high cardiovascular risks: candesartan antihypertensive survival evaluation in Japan trial. Hypertension 2008; 51: 393–398.
Mancia G, De Backer G, Dominiczak A, et al: 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007; 25: 1751–1762.
August P : Initial treatment of hypertension. N Engl J Med 2003; 348: 610–616.
Perry HM Jr, Davis BR, Price TR, et al: Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA 2000; 284: 465–471.
Staessen J, Bulpitt C, Clement D, et al: Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly. BMJ 1989; 298: 1552–1556.
Ogihara T, PATE-Hypertension Study Group in Japan: A Practitioner's Trial on the Efficacy of Antihypertensive Treatment in the Elderly Hypertension (The PATE-Hypertension Study) in Japan. Am J Hypertens 2000; 13: 461–467.
Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM : Blood pressure and survival in the oldest old. J Am Geriatr Soc 2007; 55: 383–388.
Rastas S, Pirttilä T, Viramo P, et al: Association between blood pressure and survival over 9 years in a general population aged 85 and older. J Am Geriatr Soc 2006; 54: 912–918.
van Bemmel T, Gussekloo J, Westendorp RG, Blauw GJ : In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. J Hypertens 2006; 24: 287–292.
Fukui T, Rahman M, Hayashi K, et al, CASE-J Study Group: Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) trial of cardiovascular events in highrisk hypertensive patients: rationale, design, and methods. Hypertens Res 2003; 26: 979–990.
Japanese Society of Hypertension Guidelines Subcommittee for the Management of Hypertension: Guidelines for the management of hypertension for general practitioners. Hypertens Res 2001; 24: 613–634.
Zanchetti A, Julius S, Kjeldsen S, et al: Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from VALUE trial. J Hypertens 2006; 24: 2163–2168.
Elliott WJ, Meyer PM : Incidence diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet 2007; 369: 201–207.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration: Age-specific relevance of usual blood pressure to vascular mortality, a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.
Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB : The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med 1999; 159: 2004–2009.
Kjeldsen SE, Kolloch RE, Leonetti G, et al: Influence of gender and age on preventing cardiovascular disease by antihypertensive treatment and acetylsalicylic acid. The HOT study. J Hypertens 2000; 18: 629–642.
JATOS Study Group: The Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS): protocol, patient characteristics, and blood pressure during the first 12 months. Hypertens Res 2005; 28: 513–520.
Ishii M, Goto Y, the JATOS Study Group: Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients. J Hypetens 2006; 24 ( Suppl 6): S30.
Japanese Society of Hypertension: Japanese Society of Hypertension Guidelines for the Manegement of Hypertension (JSH 2004). Hypertens Res 2006; 29: S1–S105.
Port S, Demer L, Jennrich R, Walter D, Garfinkel A : Systolic blood pressure and mortality. Lancet 2000; 355: 175–180.
Beckett NS, Peters R, Fletcher AE, et al, HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1958–1960.
Gueyffier F, Bulpitt C, Boissel JP, et al: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trilas. Lancet 1999; 353: 793–796.
Ogihara T, Saruta T, Matsuoka H, et al, VALISH Study Group: Valsartan in Elderly Isolated Systolic Hypertension (VALISH) study: rationale and design. Hypertens Res 2004; 27: 657–661.
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Ogihara, T., Nakao, K., Fukui, T. et al. The Optimal Target Blood Pressure for Antihypertensive Treatment in Japanese Elderly Patients with High-Risk Hypertension: A Subanalysis of the Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J) Trial. Hypertens Res 31, 1595–1601 (2008). https://doi.org/10.1291/hypres.31.1595
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DOI: https://doi.org/10.1291/hypres.31.1595
Keywords
- hypertension
- elderly
- blood pressure
- Candesartan Antihypertensive Survival Evaluation in Japan (CASE-J)
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