We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial | Health Care Reform

Benefits of Antihypertensive Therapy in Older Patients With Hypertension

William B. White, MD
Arch Intern Med. 2000;160(2):149-150. doi:10.1001/archinte.160.2.149.
Text Size: A A A
Published online


THE BENEFITS of treating older patients with systolic hypertension have become well known since the completion of the Systolic Hypertension in the Elderly Program (SHEP),1 a placebo-controlled trial that assessed the outcome of using diuretic-based antihypertensive therapy on stroke and related cardiovascular morbidities. Cardiovascular risk is increased substantially in older patients with hypertension when concomitant comorbid illlnesses such as diabetes mellitus2 are present or if there is a history of vascular disease such as stroke or ischemic heart disease.3 Thus, much greater attention has been placed recently on the impact of blood pressure control in patients with hypertension and increased cardiovascular risk. For example, analyses of various outcomes from the diabetic subpopulation of the Systolic Hypertension in Europe (Syst-Eur) trial4 showed significant benefit for reduction of cardiovascular mortality and morbidity following treatment with the dihydropyridine calcium antagonist nitrendipine. In the Syst-Eur trial, active treatment in the patients with diabetes and systolic hypertension reduced mortality from cardiovascular disease by 76%, and stroke and cardiac events by 73% and 69%, respectively. These relative reductions in cardiovascular events were much greater in the patients with diabetes and hypertension compared with the larger, nondiabetic hypertensive population. In addition, the absolute benefit derived from the outcome model was also substantial: "following 5 years of therapy, 178 major cardiovascular events per 1000 diabetic, hypertensive patients treated would be prevented in contrast to 39 such events in the non-diabetic hypertensive patient."4

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

12 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Hemorrhagic Stroke?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference