Implications of the Systolic Hypertension in China trial

Abstract

In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Group started to investigate whether active treatment could reduce the incidence of stroke and other cardiovascular complications of isolated systolic hypertension. After stratification for center, sex and previous cardiovascular complications, alternate patients (n = 1253) were assigned nitrendipine 10-40 mg daily, with the possible addition of captopril 12.5-50.0 mg daily, or hydrochlorothiazide 12.5-50.0 mg daily, or both drugs. In 1141 control patients, matching placebos were employed similarly. At entry, sitting blood pressure averaged 170 mm Hg systolic and 86 mm Hg diastolic, age averaged 66 years, and total serum cholesterol was 5.1 mmol/L. At 2 years, the between-group differences were 9.1 mm Hg systolic (95% confidence interval: 7.6-10.7 mm Hg) and 3.2 mm Hg diastolic (2.4-4.0). Active treatment reduced total stroke by 38% (p=0.01), all-cause mortality by 39% (p=0.003), cardiovascular mortality by 39% (p=0.03), stroke mortality by 58% (p=0.02) and all fatal and nonfatal cardiovascular endpoints by 37% (p=0.004). In conclusion, antihypertensive treatment prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension. Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes, or 59 major cardiovascular endpoints.