K. Suttontyrrell et al., BLOOD-PRESSURE TREATMENT SLOWS THE PROGRESSION OF CAROTID STENOSIS INPATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION, Stroke, 25(1), 1994, pp. 44-50
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.