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Article
November 27, 1991

Prevention of Stroke in Older Persons With Isolated Systolic Hypertension-Reply

Author Affiliations

Systolic Hypertension in the Elderly Program (SHEP) Research Group National Institutes of Health Bethesda, Md

Systolic Hypertension in the Elderly Program (SHEP) Research Group National Institutes of Health Bethesda, Md

JAMA. 1991;266(20):2829-2830. doi:10.1001/jama.1991.03470200041014
Abstract

In Reply.  —In response to the positive results of the Systolic Hypertension in the Elderly Program (SHEP) trial, both Drs Simon and Mann urge that only some people with isolated systolic hypertension be treated. Simon states that stroke incidence was low, hence the "public health impact of treating isolated systemic hypertension is expected to be modest." The public health implications of SHEP go well beyond reduction in the incidence of stroke; 17.5% of SHEP participants in the placebo group experienced a major cardiovascular event during a mean follow-up period of only 4.5 years. This incidence was reduced to 12.2% in the active-treatment group, which means the prevention of 55 events per 1000 patients in the first 5 years of treatment. The public health impact can be estimated: since about 4 million people in the United States currently have isolated systolic hypertension,1 the treatment used in SHEP could prevent about

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