IMPACT OF THE TREATMENT OF ISOLATED SYSTOLIC HYPERTENSION ON BEHAVIORAL VARIABLES - RESULTS FROM THE SYSTOLIC HYPERTENSION IN THE ELDERLY PROGRAM

Background: Little information has been published on the impact of ant ihypertensive medications on quality of life in older persons. Particu lar concern has existed that lowering systolic blood pressure in older persons might have adverse consequences on cognition, mood, or leisur e activities. Methods: A multicenter double-blind randomized controlle d trial was conducted over an average of 5 years' followup involving 1 6 academic clinical trial clinics. Participants consisted of 4736 pers ons (1.06%) selected from 447 921 screenees aged 60 years and older. S ystolic blood pressure at baseline ranged from 160 to 219 mm Hg, while diastolic blood pressure was less than 90 mm Hg. Participants were ra ndomized to active antihypertensive drug therapy or matching placebo. Active treatment consisted of 12.5 to 25 mg of chlorthalidone for step 1, while step 2 consisted of 25 to 50 mg of atenolol. If atenolol was contraindicated, 0.05 to 0.10 mg of reserpine could be used for the s econd-step drug. The impact of drug treatment on measures of cognitive , emotional, and physical function and leisure activities was assessed . Results: Our analyses demonstrate that active treatment of isolated systolic hypertension in the Systolic Hypertension in the Elderly Prog ram cohort had no measured negative effects and, for some measures, a slight positive effect on cognitive, physical, and leisure function. T he positive findings in favor of the treatment group were small. There was no effect on measures related to emotional state. Measures of cog nitive and emotional function were stable in both groups for the durat ion of the study. Both treatment groups showed a modest trend toward d eterioration of some measures of physical and leisure function over th e study period. Conclusions: The overall study cohort exhibited declin e over time in activities of daily living, particularly the more stren uous ones, and some decline in certain leisure activities. However, mo od, cognitive function, basic self-care, and moderate leisure activity were remarkably stable for both the active and the placebo groups thr oughout the entire study. Results of this study support the inference that medical treatment of isolated systolic hypertension does not caus e deterioration in measures of cognition, emotional state, physical fu nction, or leisure activities.