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Original Investigation
December 8/22, 2003

Extent of Cardiovascular Risk Reduction Associated With Treatment of Isolated Systolic Hypertension

Author Affiliations

From the Department of Epidemiology, Graduate School of Public Health (Drs Sutton-Tyrrell, Wildman, and Kuller), and the Division of Geriatrics, Department of Medicine (Dr Newman), University of Pittsburgh, Pittsburgh, Pa. The authors have no relevant financial interest in this article.

Arch Intern Med. 2003;163(22):2728-2731. doi:10.1001/archinte.163.22.2728

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.