October 4, 1996
76 yo BF found with persistent blood pressure of 160-180/70-80.
-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.
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|
|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)|
|Total deaths||213||242||0.87 (0.73-1.05)|
|Total cardiovascular||90||112||0.80 (0.60-1.05)|
|Total coronary heart disease||59||73||0.80 (0.57-1.13)|
-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.
-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