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Systolic Hypertension in Elderly Program (SHEP) trial

Randomized, placebo-controlled trial, 1985-1990, 16 US clinical centers Subjects: 4736 men & women age >= 60 years of age with a mean blood pressure of 170/77 mm Hg Treatment: 1) start 12.5 mg of chlorthalidone, increasing to 25 mg QD 2) add atenolol or reserpine as needed 3) treatment goal: systolic BP < 140 mm Hg Results: 1) blood pressure decreased to a mean of 143/68 mm Hg in the treatment group 2) blood pressure decreased to 155/72 mm Hg in placebo group 3) at 5 years, the incidence of stroke was 8.2% in the placebo group vs 5.3% in the treated group 4) a 25% decrease in cardiac events in the treatment group was not statistically significant 5) 13% decrease in left ventricular mass index in treatment group vs 6% in placebo group 6) only 70% of patients in treatment group reached treatment goal 7) no reduction in dementia or disability [2] 8) hypokalemia abolished benefit of chlorthalidone [4] 9) benefit in mortality seem in treatment group at 22 years; gain in life-expectancy ~ 6 months [7]

Related

systolic hypertension (hypertension in the elderly)

General

hypertension clinical trials

References

  1. Kostis JB, Lawrence-Nelson J, Ranjan R, Wilson AC, Kostis WJ, Lacy CR. Association of increased pulse pressure with the development of heart failure in SHEP. Systolic Hypertension in the Elderly (SHEP) Cooperative Research Group. Am J Hypertens. 2001 Aug;14(8 Pt 1):798-803. PMID: 11497197
  2. Di Bari M, Pahor M, Franse LV, Shorr RI, Wan JY, Ferrucci L, Somes GW, Applegate WB. Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in the elderly program (SHEP) trial. Am J Epidemiol. 2001 Jan 1;153(1):72-8. PMID: 11159149
  3. Perry HM Jr, Davis BR, Price TR, Applegate WB, Fields WS, Guralnik JM, Kuller L, Pressel S, Stamler J, Probstfield JL. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 2000 Jul 26;284(4):465-71. PMID: 10904510
  4. Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension. 2000 May;35(5):1025-30. PMID: 10818057
  5. Curb JD, Pressel SL, Cutler JA, Savage PJ, Applegate WB, Black H, Camel G, Davis BR, Frost PH, Gonzalez N, Guthrie G, Oberman A, Rutan GH, Stamler J. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA. 1996 Dec 18;276(23):1886-92. Erratum in: JAMA 1997 May 7;277(17):1356. PMID: 8968014
  6. Kostis JB et al, Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group. JAMA. 1997 278:212 PMID: 9218667
  7. Kostis JB et al Association Between Chlorthalidone Treatment of Systolic Hypertension and Long-term Survival JAMA. 2011;306(23):2588-2593 PMID: 22187278 http://jama.ama-assn.org/content/306/23/2588.short