Multicenter, prospective, randomised, open study comparing the effect of the following two strategies in hypertensive subjects > 55 years and poorly controlled (systolic blood pressure >= 150 mmHg) by antihypertensive treatment:

• usual strategy: reduction of systolic blood pressure to below 140 mmHg, independently of diastolic blood pressure levels;
• intensive strategy: reduction of systolic blood pressure to below 130 mmHg, independently of diastolic blood pressure levels.

During the initial run in period two qualifying visits at distance of 7-14 days will be carried out to establish whether blood pressure remains uncontrolled (systolic blood pressure >=150 mmHg)by current drug treatment. At the end of the second visit eligible patients will be admitted to the study and the following examinations will be carried out: clinical visit, routine laboratory tests, 12-lead ECG. At this point eligible patients will be randomised to one of the two blood pressure goals outlined above.

Subsequent clinical visits will be carried out at 4 month-intervals up to the end of the study (4, 8, 12, 16, 20, 24 months).

Study partially sponsored by: Boehringer Ingelheim, Sanofi-Aventis, Pfizer

• Drug: Triatec 10 mg
• Drug: Triatec HCT 5
• Drug: Lasix 25
• Drug: Micardis 80 mg
• Drug: Micardis plus 80/12.5
• Drug: Catapresan TTS 2
• Drug: Norvasc 10 mg
• Drug: Triatec 5 mg
• Drug: Pluscor

• Cardio-Sis Study Group. Randomized study of traditional versus aggressive systolic blood pressure control (Cardio-Sis): rationale, design and characteristics of the study population. J Hum Hypertens. 2008 Apr;22(4):243-51. Epub 2007 Nov 29.
• Verdecchia P, Staessen JA, Angeli F, de Simone G, Achilli A, Ganau A, Mureddu G, Pede S, Maggioni AP, Lucci D, Reboldi G; Cardio-Sis investigators. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet. 2009 Aug 15;374(9689):525-33.

Inclusion Criteria:

• written informed consent to the study
• age >= 55 years at randomization. There is no upper age limit
• systolic blood pressure >= 150 mmHg in 2 visits at distance of 7-14 days, irrespective of diastolic pressure. Duration of treatment before visit 1 must be at least 12 weeks
• at least one additional risk factor including the following:
• current cigarette smoking
• total cholesterol >= 20 mmg/dl, or HDL < 40 mg/dl, or LDL cholesterol >= 130 mg/dl
• family history of cardiovascular disease in male first degree relative < 55 years or female first degree relative < 65 years
• previous TIA or stroke
• previous coronary artery disease
• history of peripheral occlusive arterial disease (claudicatio intermittens associated with angiographic or echographic evidence of > 60% stenosis)

Exclusion Criteria:

• diabetes (fasting glucose > 125 mg/dl in two samples or ongoing diabetic treatment)
• renal failure, defined by a serum creatinine > 2.0 mg/dl
• chronic atrial fibrillation or flutter
• clinically significant hepatic or hematological disorders, alcoholism, drug addiction
• causes precluding ECG interpretation for LVH: complete right or left bundle block, Wolff-Parkinson-White syndrome, previous Q-wave myocardial infarction
• any disease causing reduced life expectancy
• unwilling to participate
• significant (more than traces of) valvular heart disease