Does treatment of isolated systole hypertension in the elderly lower the incidence of stroke and coronary disease?

Tim Joos
October 4, 1996


Clinical Scenario:

76 yo BF found with persistent blood pressure of 160-180/70-80.


Clinical Bottom Line:

-In patients age 60 and over with isolated systolic blood pressure, successfully reducing the blood pressure with     thiazides +/- beta-blocker reduces the total incidence of stroke by 36% and myocardial infarction by 27%
-Absolute risk reduction: For 100 patients treated, 5.5 cardiovascular events would be prevented over 5 years.


The Evidence:


Design: SHEP study (1985-1990), multi center, double-blinded, randomized,
placebo controlled trial.
Participants: 4736 patients age 60 and over, multi-ethnic-ethnic, with isolated
systolic hypertension (SBP > 160, DBP <90).
Methods: Active treatment group - (chlorthalidone 12.5 - 25 mg/d +/- atenolol 25
- 50 mg/d or reserpine 0.05 -0.1 mg/d) versus placebo.

 

Table 6.Morbidity  and Mortality by Cause and Treatment Group

No. of Events

                                                       Active Treatment                     Placebo Group                               Relative Risk
                                                        Group (n =2365)                      (n = 2371)                          (95% Confidence Interval)*
Nonfatal Events
Stroke 96 149 0.63 (0.49-0.82)
Transient ischemic attack 62 82 0.75 (0.54-1.04)
Myocardial infarctiont 50 74 067 (0.47-0.96)
Coronary artery bypass graft 30 47 0.63 (0.40-1.00)
Left ventricular failure 48 102 0.86 (0.47-1.59)
Renal dysfunction 7 11 ------------
Fatal Events
Total deaths 213 242 0.87 (0.73-1.05)
Total cardiovascular 90 112 0.80 (0.60-1.05)
Stroke 10 14 0.71 (0.31-1.59)
Total coronary heart disease 59 73 0.80 (0.57-1.13)

 

Comments:

-Patients previously on antihypertensive therapy prior to entering the study obtained the same risk reduction as     those not previously on medication.
-Risk reduction similar regardless of age, sex, race, or baseline SBP. -Risk reduction similar in patients with         or without ECG abnormalities.
-Treatment regimen was associated only with infrequent adverse effect and no evidence of increased dementia of   depression.

 

References:

-Systolic Hypertension in the Elderly Program (SHEP). Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension.JAMA. 1991;265:3255-3264.
-Lever A, Ramsay L. Treatment of hypertension in the elderly. Journal of Hypertension. 1995;13:571-579