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Diuretic improved life expectancy of patients with systolic hypertension
Kostis JB. JAMA. 2011;306:2588-2593.
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Patients with isolated systolic hypertension who were treated with chlorthalidone-based stepped-care therapy for 4.5 years in the SHEP trial experienced a significantly lower rate of death and a longer life expectancy compared with placebo.
Researchers analyzed data from the Systolic Hypertension in the Elderly Program (SHEP), a randomized, placebo-controlled, clinical trial designed to assess the effect of antihypertensive drug treatment on the reduction of stroke in patients with isolated systolic hypertension. From 1985 to 1990, patients enrolled in the trial were randomly assigned to active therapy (n=2,365) or placebo (n=2,371) for 4.5 years. All patients were then assigned on active therapy.
After 22 years of follow-up, 1,416 deaths (59.9%) occurred in the active treatment group and 1,435 deaths (60.5%) occurred in the placebo group. In the active treatment group, 12.4% of deaths were related to coronary heart disease and 4.6% of deaths were related to stroke compared with 13.6% of CHD-related deaths and 5.6% of stroke-related deaths in the placebo group.
Both life expectancy and time to the 70th percentile survival at the end of follow-up were longer for patients randomly assigned to the active treatment group vs. the placebo group. Life expectancy gain at 22 years was 158 days for cardiovascular death and 105 days for all-cause death. The gain in life expectancy free from CV death corresponds with 1 day (0.89 days) gained per month of treatment. For all-cause mortality, the gain in life expectancy from 1 month of antihypertensive drug treatment was estimated at a half day (0.59 days), according to a press release.
Additionally, researchers found that the active treatment group was associated with a higher survival free from CV death vs. the placebo group (28.3% vs. 31%).
Disclosure: The researchers report no relevant financial disclosures.
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Recent work suggests that BP in the pre-hypertension range (121-139/81-89 mmHg) may be associated with an increased risk of stroke. Antihypertensive treatment may even lower the risk of cardiovascular events in patients with CVD who are not hypertensive. The importance of lifestyle interventions as a means of both lowering BP and reducing vascular risk, including stroke, needs to be reinforced. For example, both men and women who have a healthy diet, don't smoke, have a normal BMI, exercise regularly and don't drink alcohol to excess have an approximate 80% lower risk of a first stroke compared to those who don't follow this lifestyle. The report by Kostis et al. further supports the importance of BP control, even with treatment for a limited period. The importance of lifestyle as a means of lowering BP and reducing vascular risk needs continued emphasis.
– Larry B. Goldstein, MD, FAAN, FAHA
Director, Duke Stroke Center
Durham, NC
Disclosure: Dr. Goldstein reports no relevant financial disclosures.
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