Practitioner's Trial on the Efficacy of Antihypertensive Treatment in Elderly Patients with Hypertension II (PATE-Hypertension II study) in Japan

Aim: Reduction of elevated blood pressure (BP) has been an important treatment goal in elderly hypertensive patients. However, it has been reported that an excessive reduction of systolic BP to less than 120 mmHg might be harmful in such patients. We investigated whether this was the case in a study which assessed long-term antihypertensive efficacy, tolerability and impact on cardiovascular/cerebrovascular (CV) morbidity/mortality in a large cohort of Japanese patients. Methods: This study was performed at general practitioners' offices nationwide with a target sample size of 1500 patients. Hypertensive patients aged 60 years or more who achieved successful BP control with candesartan monotherapy, and who tolerated the treatment for at least 8 weeks, were enrolled into the study and followed for 3 years. Results: BP was maintained below the target level of 140/90 mmHg over the 3-year period. The incidence of CV events during the study period was 20.4/1000 person-years. Investigation of the relationship between BP and the incidence of CV events revealed that patients with higher BP generally had a higher incidence of events. However, very elderly patients (>= 75 years) with a systolic BP (SBP) of less than 120 mmHg also had a higher incidence of CV events compared with those with an SBP of 120-139 mmHg. Conclusion: This study demonstrated that treatment with candesartan maintained long-term control of BP in elderly hypertensive patients without serious adverse events. CV events demonstrated a J-curve relationship with SBP in patients aged 75 years or older, which suggests that excessive BP reductions might be harmful for very elderly patients. Geriatr Gerontol Int 2011; 11: 414-421.