BACKGROUND: The Systolic Hypertension in the Elderly Program (SHEP) demonstrated the benefit of treating isolated systolic hypertension (ISH) in older adults. However, nearly 20% of older adults remain at high risk of heart disease and stroke from untreated ISH. METHODS: For the Pittsburgh SHEP cohort, 11- to 14-year death or cardiovascular event rates were compared for active (n = 135) and placebo (n = 133) arms plus normotensive controls (n = 187). Carotid ultrasound and ankle blood pressures were used to identify subclinical atherosclerosis at baseline. RESULTS: Fourteen-year Kaplan-Meier event rate estimates were 58% vs 79% for the active vs placebo groups (P =.001). Eleven-year event rates for the control, active, and placebo groups were 35%, 47%, and 65%, respectively. Compared with controls, the relative risk of an event was 1.6 (95% confidence interval, 1.1-2.4) for the active treatment group and 3.0 (95% confidence interval, 2.1-4.4) for the placebo group. Baseline history of cardiovascular disease was present in 19% of SHEP participants vs 15% of controls (P =.32), and subclinical disease (carotid stenosis or low ankle blood pressure) was detected in 33% of SHEP participants vs 10% of controls (P<.001). Among those with no clinical or subclinical disease at baseline, the ISH group assigned to active treatment had 10-year event rates similar to those of the control group (29% vs 27%), whereas the placebo rates were much higher (69%). CONCLUSIONS: Treatment of ISH in older adults results in reduced event rates in 14 years. Treatment before advanced atherosclerosis develops will likely produce the best long-term outcome.
RCT Entities:
BACKGROUND: The Systolic Hypertension in the Elderly Program (SHEP) demonstrated the benefit of treating isolated systolic hypertension (ISH) in older adults. However, nearly 20% of older adults remain at high risk of heart disease and stroke from untreated ISH. METHODS: For the Pittsburgh SHEP cohort, 11- to 14-year death or cardiovascular event rates were compared for active (n = 135) and placebo (n = 133) arms plus normotensive controls (n = 187). Carotid ultrasound and ankle blood pressures were used to identify subclinical atherosclerosis at baseline. RESULTS: Fourteen-year Kaplan-Meier event rate estimates were 58% vs 79% for the active vs placebo groups (P =.001). Eleven-year event rates for the control, active, and placebo groups were 35%, 47%, and 65%, respectively. Compared with controls, the relative risk of an event was 1.6 (95% confidence interval, 1.1-2.4) for the active treatment group and 3.0 (95% confidence interval, 2.1-4.4) for the placebo group. Baseline history of cardiovascular disease was present in 19% of SHEP participants vs 15% of controls (P =.32), and subclinical disease (carotid stenosis or low ankle blood pressure) was detected in 33% of SHEP participants vs 10% of controls (P<.001). Among those with no clinical or subclinical disease at baseline, the ISH group assigned to active treatment had 10-year event rates similar to those of the control group (29% vs 27%), whereas the placebo rates were much higher (69%). CONCLUSIONS: Treatment of ISH in older adults results in reduced event rates in 14 years. Treatment before advanced atherosclerosis develops will likely produce the best long-term outcome.
Authors: Jerome L Fleg; Daniel E Forman; Kathy Berra; Vera Bittner; James A Blumenthal; Michael A Chen; Susan Cheng; Dalane W Kitzman; Mathew S Maurer; Michael W Rich; Win-Kuang Shen; Mark A Williams; Susan J Zieman Journal: Circulation Date: 2013-10-28 Impact factor: 29.690
Authors: Patrick J O'Connor; Edward Gregg; William A Rush; Linda M Cherney; Michael N Stiffman; Michael M Engelgau Journal: Ann Fam Med Date: 2006 Jan-Feb Impact factor: 5.166
Authors: Felix Mahfoud; George Bakris; Deepak L Bhatt; Murray Esler; Sebastian Ewen; Martin Fahy; David Kandzari; Kazuomi Kario; Giuseppe Mancia; Michael Weber; Michael Böhm Journal: Eur Heart J Date: 2017-01-07 Impact factor: 29.983
Authors: Joel M Neutel; David H G Smith; Michael A Weber; Lesley Schofield; Das Purkayastha; Marjorie Gatlin Journal: J Clin Hypertens (Greenwich) Date: 2005-11 Impact factor: 3.738