Conclusions and Implications of the Systolic Hypertension in the Elderly Program

Abstract

Isolated systolic hypertension has a higher prevalence with age and an associated excess cardiovascular risk. The Systolic Hypertension in the Elderly Program (SHEP) was a randomized, prospective, double blind clinical trial to assess the efficacy and safety of a antihypertensive regimen based on low dose diuretic therapy in reducing the five year combined incidence of fatal and nonfatal stroke. SHEP demonstrated a significant 36% reduction in stroke incidence. Also, 27% reduction in coronaryheart disease incidence and a 32% reduction in major cardiovascular disease incidencewere achieved. Thebenefits accrued to all subgroups identifiedbased onbaseline age, race, sex, blood pressure, serum cholesterol levels, and ECG abnormalities. A low-dose diuretic regimen should be the initial treatment of choice for most hypertensive patients, based on demonstrated reduction in risk for major cardiovascular events, its safety, acceptanceby patients, and low cost.

Key Words:

• hypertension
• systolic
• age factors
• clinical trials
• antihypertensive therapy