Patients with isolated systolic hypertension who were treated with
chlorthalidone-based stepped-care therapy for 4.5 years in the SHEP trial
experienced a significantly lower rate of death and a longer life expectancy
compared with placebo.
Researchers analyzed data from the Systolic Hypertension in the Elderly
Program (SHEP), a randomized, placebo-controlled, clinical trial designed to
assess the effect of
antihypertensive drug treatment on the reduction of stroke in
patients with isolated systolic hypertension. From 1985 to 1990, patients
enrolled in the trial were randomly assigned to active therapy (n=2,365) or
placebo (n=2,371) for 4.5 years. All patients were then assigned on active
After 22 years of follow-up, 1,416 deaths (59.9%) occurred in the active
treatment group and 1,435 deaths (60.5%) occurred in the placebo group. In the
active treatment group, 12.4% of deaths were related to
CHD and 4.6% of deaths were related to stroke compared with
13.6% of CHD-related deaths and 5.6% of stroke-related deaths in the placebo
Both life expectancy and time to the 70th percentile survival at the end
of follow-up were longer for patients randomly assigned to the active treatment
group vs. the placebo group. Life expectancy gain at 22 years was 158 days for
CV death and 105 days for all-cause death. The gain in life expectancy free
from CV death corresponds with 1 day (0.89 days) gained per month of treatment.
For all-cause mortality, the gain in life expectancy from 1 month of
antihypertensive drug treatment was estimated at a half day (0.59 days),
according to a press release.
Additionally, researchers found that the active treatment group was
associated with a higher survival free from CV death vs. the placebo group
(28.3% vs. 31%).
Disclosure: The researchers report no relevant financial
Recent work suggests that BP in the pre-hypertension range (121-139 mm Hg/81-89 mm Hg) may be associated with an increased risk for stroke. Antihypertensive treatment may even lower the risk for CV events in patients with CVD who are not hypertensive. The importance of lifestyle interventions as a means of both lowering BP and reducing vascular risk, including stroke, needs to be reinforced. For example, both men and women who have a healthy diet, do not smoke, have a normal BMI, exercise regularly and do not drink alcohol to excess have an approximate 80% lower risk for a first stroke compared with those who do not follow this lifestyle. The report by Kostis et al further supports the importance of BP control, even with treatment for a limited period.
– Larry B. Goldstein, MD, FAAN, FAHA
Cardiology Today Editorial Board member
Disclosure: Dr. Goldstein reports no relevant financial