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The Systolic Hypertension in Europe Trial

About 15% of men and women aged at least 60 years have isolated systolic hypertension (ISH). In 1989, the European Working Party on High Blood Pressure in the Elderly initiated the double-blind placebo-controlled Syst-Eur (Systolic Hypertension in Europe) trial to investigate whether a calcium-channel blocker (CCB)-based regimen could reduce the cardiovascular complications associated with ISH. The primary endpoint was the incidence of fatal and nonfatal stroke. The Syst-Eur trial stopped after the second of four planned interim analyses when it was revealed that a CCB-based intervention reduced the incidence of stroke, according to predefined criteria.¹

Four conclusions were drawn from the Syst-Eur trial results.

• The trial confirmed the findings of the Systolic Hypertension in the Elderly Program (SHEP) – older patients with isolated systolic hypertension should be treated to prevent or postpone stroke and other cardiovascular complications.²

• Long-acting nifedipine-type CCBs are a valid alternative to diuretics and beta blockers in the primary prevention of cardiovascular disorders in elderly hypertensive patients.

• Calcium-channel blockade may be particularly beneficial in patients with diabetes and ISH, and in patients at risk of dementia.

• The double-blind, placebo-controlled trial showed no evidence of potentially dangerous side-effects with CCBs, as had previously been claimed.

1. Staessen JA, et al. Lancet 1997;350:757–64.
2. SHEP Cooperative Research Group. JAMA 1991; 265:3255–64.