Extent of cardiovascular risk reduction associated with treatment of isolated systolic hypertension

Arch Intern Med. 2003 Dec;163(22):2728-31. doi: 10.1001/archinte.163.22.2728.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Arteriosclerosis / complications
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Case-Control Studies
  • Double-Blind Method
  • Follow-Up Studies
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Life Tables
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors


  • Antihypertensive Agents