New findings from completed studies and future directions - systolic hypertension in the elderly trial (SHEP)

Final results from Systolic Hypertension in the Elderly Program (SHEP) were published in June 1991. It was the first long-term randomized double blind trial demonstrating efficacy of pharmacologic treatment for those with Isolated Systolic Hypertension (ISH). Reductions in incidence of fatal and non-fatal stroke (36%), coronary heart disease (27%), all cardiovascular events (32%), and congestive heart failure (54%) were observed using a low dose stepped care approach (chlorthalidone, atenolol, or reserpine). A low order of adverse effects was observed while BP was effectively lowered and maintained throughout follow-up. Subsequent analyses have produced additional important results: 1) Benefits of therapy were present regardless of race, sex, age or level of baseline blood pressure. 2) Severity of stroke was less and level of physical disability was less impaired for those on active therapy. 3) Inclusion of silent infarctions in CHD analyses provided similar results. 4) Time dependent covariate analyses suggest reduction in events was related to blood pressure lowering rather than type of drug used. 5) Variables indicative of glucose metabolism were relatively stable in those with and without disorders of glucose metabolism at baseline. All additional analyses strongly support the broad applicability of the low dose diuretic approach to reduction of sustained ISH and reduction in clinical endpoints and other measures of morbidity with low levels of associated risk.