Document Detail

Extent of cardiovascular risk reduction associated with treatment of isolated systolic hypertension.
MedLine Citation:
PMID:  14662626     Owner:  NLM     Status:  MEDLINE    
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.
Kim Sutton-Tyrrell; Rachel Wildman; Anne Newman; Lewis H Kuller
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  163     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:    2003 Dec 8-22
Date Detail:
Created Date:  2003-12-09     Completed Date:  2004-01-07     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2728-31     Citation Subset:  AIM; IM    
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa 15261, USA.
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MeSH Terms
Antihypertensive Agents / therapeutic use*
Arteriosclerosis / complications
Cardiovascular Diseases / mortality,  prevention & control*
Case-Control Studies
Double-Blind Method
Follow-Up Studies
Hypertension / complications,  drug therapy*
Life Tables
Middle Aged
Prospective Studies
Risk Factors
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents
Comment In:
Arch Intern Med. 2003 Dec 8-22;163(22):2677-8   [PMID:  14662620 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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