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Extent of Cardiovascular Risk Reduction Associated With Treatment of Isolated Systolic Hypertension
Kim Sutton-Tyrrell, DrPH;
Rachel Wildman, PhD;
Anne Newman, MD, MPH;
Lewis H. Kuller, MD, DrPH
Arch Intern Med. 2003;163:2728-2731.
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.
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.
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