Conclusions and implications of the systolic hypertension in the elderly program

Clin Exp Hypertens. 1993 Nov;15(6):911-24. doi: 10.3109/10641969309037081.


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 coronary heart disease incidence and a 32% reduction in major cardiovascular disease incidence were achieved. The benefits accrued to all subgroups identified based on baseline 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, acceptance by patients, and low cost.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use*
  • Atenolol / therapeutic use
  • Blood Pressure
  • Cerebrovascular Disorders / epidemiology*
  • Cerebrovascular Disorders / etiology*
  • Cerebrovascular Disorders / mortality
  • Diuretics / therapeutic use*
  • Double-Blind Method
  • Female
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy*
  • Hypertension / physiopathology
  • Incidence
  • Male
  • Prospective Studies
  • Survival Analysis
  • Systole


  • Antihypertensive Agents
  • Diuretics
  • Atenolol