K. Suttontyrrell et al., MORBIDITY, MORTALITY, AND ANTIHYPERTENSIVE TREATMENT EFFECTS BY EXTENT OF ATHEROSCLEROSIS IN OLDER ADULTS WITH ISOLATED SYSTOLIC HYPERTENSION, Stroke, 26(8), 1995, pp. 1319-1324
Background and Purpose The Systolic Hypertension in the Elderly Progra
m (SHEP) demonstrated a significant reduction in stroke and coronary e
vent rates among participants randomly assigned to active blood pressu
re treatment. Selected participants were evaluated for peripheral athe
rosclerosis and followed up for cardiovascular events beyond the end o
f the SHEP trial. Antihypertensive treatment effects were evaluated ba
sed on the presence or absence of clinical or subclinical atherosclero
sis. Methods As an ancillary study to SHEP, 190 participants at the Pi
ttsburgh center were evaluated for peripheral atherosclerosis, defined
as either an internal carotid stenosis (by duplex scan) or lower extr
emity arterial disease (identified by ankle blood pressure). Participa
nts were subsequently followed up for cardiovascular events. Results E
stimates of 4-year mortality rates were 4.8% for participants with no
atherosclerosis, 16.7% for those with subclinical atherosclerosis, and
23% among those with clinical evidence of atherosclerosis (P < .001).
Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and
58.3% for the three groups, respectively (P < .001). Differences rema
ined significant after adjustment for age, sex, treatment assignment,
smoking, and high-density lipoprotein cholesterol. Individuals assigne
d to placebo at the beginning of SKEP had higher cardiovascular event
rates than individuals assigned to active treatment (P = .011), with t
he most striking difference 3 or more years after the end of the SHEP
trial. When this analysis was stratified by the presence or absence of
detectable atherosclerosis, the absolute treatment effect was largest
among those with evidence of disease. Conclusions Individuals with sy
stolic hypertension and evidence of peripheral atherosclerosis are at
high risk for cardiovascular events. Targeting this group for antihype
rtensive therapy would result in the prevention of a large number of c
ardiovascular events.