BLOOD-PRESSURE TREATMENT SLOWS THE PROGRESSION OF CAROTID STENOSIS INPATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION

Background and Purpose The Systolic Hypertension in the Elderly Progra m (SHEP) was a randomized trial testing the efficacy of treating systo lic hypertension in older adults. A significant reduction in stroke ri sk was observed among participants assigned to active treatment. Seria l carotid duplex scans were performed on 129 participants at the Unive rsity of Pittsburgh center, and rates of progression and regression of carotid stenosis were observed. Methods Changes in blood flow velocit y ratios were used to detect progression because they can be reliably measured and their relation to degree of residual lumen is known. Prog ression required the development of a 40% to 50% diameter stenosis whe n stenosis was not initially present or, if already present, further r eduction in the lumen diameter. Regression required the absence of a 4 0% to 50% diameter stenosis when stenosis was initially present or a s tenosis significantly less severe than that initially seen. Results Pr ogression occurred in 22% (28/129) of participants and regression in 1 6% (8/49). Progression of carotid stenosis occurred more often among p articipants randomized to placebo as compared with active treatment (3 1% versus 14%, P=.020). All eight patients exhibiting regression were randomized to active treatment. In multivariate analysis, participants assigned to placebo had 4.3 times greater odds of progressing than pa rticipants assigned to active treatment. Other factors significantly r elated to progression were higher degree of plaque at baseline, low hi gh-density lipoprotein-3, high lipoprotein(a), and younger age. Conclu sions Treating systolic hypertension appears to slow progression of ca rotid stenosis. Similar effects occurring in the intracranial vessels may be one reason for the substantial decrease in stroke among SHEP pa rticipants assigned to active treatment.