Benefits of treating systolic hypertension
Older adults with isolated systolic hypertension gained about 5 months of life when treated with chlorthalidone-based stepped care 2 decades after completion of the Systolic Hypertension in the Elderly Program (SHEP) trial. SHEP, conducted between 1985 and 1990, was a clinical trial of patients aged 60 years or older (mean age 72) with isolated systolic hypertension who were randomized to chlorthalidone-based antihypertensive therapy or placebo. Over a mean follow-up of 4.5 years, chlorthalidone-based therapy resulted in prevention of approximately 1 of 2 admissions for heart failure, 1 out of 3 fatal or nonfatal strokes, and 1 of 4 coronary heart disease events, but there was no effect on all-cause mortality or cardiovascular death. At the end of the trial, all participants were advised to receive active therapy. The new study reviewed cardiovascular death and all-cause mortality in SHEP trial participants 22 years after the study ended. Life expectancy gain between the active treatment group and placebo group was 105 days (95% confidence interval [CI], -39 to 242; P = 0.07) for all-cause mortality and 158 days (95% CI, 36-287; P = 0.009) for cardiovascular death. Each month of active treatment was associated with approximately 1 day extension in life expectancy. The authors conclude that treatment of isolated systolic hypertension with chlorthalidone stepped-care therapy for 4.5 years was associated with longer life expectancy at 22 years of follow-up (JAMA 2011;306:2588-2593). This study may help convince older patients with systolic hypertension that compliance with diuretic-based hypertensive therapy is worth the effort as it will prolong their lives.