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Results From the Systolic Hypertension in the Elderly Program

William B. Applegate, MD, MPH; Sara Pressel, MS; Janet Wittes, PhD; Judith Luhr, PhD; Richard B. Shekelle, PhD; Greta H. Camel, MD; Merwyn R. Greenlick, PhD; Evan Hadley, MD; Lemuel Moye, MD, PhD; H. Mitchell Perry, Jr, MD; Eleanor Schron, RN, MS; Vicki Wegener, RN, FNP

Arch Intern Med. 1994;154(19):2154-2160.

Abstract
Background
Little information has been published on the impact of antihypertensive medications on quality of life in older persons. Particular concern has existed that lowering systolic blood pressure in older persons might have adverse consequences on cognition, mood, or leisure activities.

Methods
A multicenter double-blind randomized controlled trial was conducted over an average of 5 years' followup involving 16 academic clinical trial clinics. Participants consisted of 4736 persons (1.06%) selected from 447 921 screenees aged 60 years and older. Systolic blood pressure at baseline ranged from 160 to 219 mm Hg, while diastolic blood pressure was less than 90 mm Hg. Participants were randomized to active antihypertensive drug therapy or matching placebo. Active treatment consisted of 12.5 to 25 mg of chlorthalidone for step 1, while step 2 consisted of 25 to 50 mg of atenolol. If atenolol was contraindicated, 0.05 to 0.10 mg of reserpine could be used for the second-step drug. The impact of drug treatment on measures of cognitive, emotional, and physical function and leisure activities was assessed.

Results
Our analyses demonstrate that active treatment of isolated systolic hypertension in the Systolic Hypertension in the Elderly Program cohort had no measured negative effects and, for some measures, a slight positive effect on cognitive, physical, and leisure function. The positive findings in favor of the treatment group were small. There was no effect on measures related to emotional state. Measures of cognitive and emotional function were stable in both groups for the duration of the study. Both treatment groups showed a modest trend toward deterioration of some measures of physical and leisure function over the study period.

Conclusions
The overall study cohort exhibited decline over time in activities of daily living, particularly the more strenuous ones, and some decline in certain leisure activities. However, mood, cognitive function, basic self-care, and moderate leisure activity were remarkably stable for both the active and the placebo groups throughout the entire study. Results of this study support the inference that medical treatment of isolated systolic hypertension does not cause deterioration in measures of cognition, emotional state, physical function, or leisure activities.

(Arch Intern Med. 1994;154:2154-2160)

Author Affiliations
From the University of Tennessee, Memphis (Dr Applegate); University of Texas Houston Health Science Center School of Public Health (Ms Pressel and Drs Shekelle and Moye); Statistics Collaborative, Washington, DC (Dr Wittes); The Holliswood (NY) Hospital (Dr Luhr); Washington University School of Medicine, St Louis, Mo (Drs Camel and Perry); Kaiser Permanente Center for Health Research, Portland, Ore (Dr Greenlick and Ms Wegener); National Institute on Aging, National Institutes of Health, Bethesda, Md (Dr Hadley); and the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md (Ms Schron).

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