Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group.
BACKGROUND
Heart failure is often preceded by isolated systolic hypertension, but the effectiveness of antihypertensive treatment in preventing heart failure is not known.


OBJECTIVE
To assess the effect of diuretic-based antihypertensive stepped-care treatment on the occurrence of heart failure in older persons with isolated systolic hypertension.


METHODS
Analysis of data from a multicenter, randomized, double-blind, placebo-controlled clinical trial.


METHODS
A total of 4736 persons aged 60 years and older with systolic blood pressure between 160 and 219 mm Hg and diastolic blood pressure below 90 mm Hg who participated in the Systolic Hypertension in the Elderly Program (SHEP).


METHODS
Stepped-care antihypertensive drug therapy, in which the step 1 drug is chlorthalidone (12.5-25 mg) or matching placebo, and the step 2 drug is atenolol (25-50 mg) or matching placebo.


METHODS
Fatal and nonfatal heart failure.


RESULTS
During an average of 4.5 years of follow-up, fatal or nonfatal heart failure occurred in 55 of 2365 patients randomized to active therapy and 105 of the 2371 patients randomized to placebo (relative risk [RR], 0.51; 95% confidence interval [CI], 0.37-0.71; P<.001; number needed to treat to prevent 1 event [NNT], 48). Among patients with a history of or electrocardiographic evidence of prior myocardial infarction (MI), the RR was 0.19 (95% CI, 0.06-0.53; P=.002; NNT, 15). Older patients, men, and those with higher systolic blood pressure or a history of or electrocardiographic evidence of MI at baseline had higher risk of developing heart failure.


CONCLUSIONS
In older persons with isolated systolic hypertension, stepped-care treatment based on low-dose chlorthalidone exerted a strong protective effect in preventing heart failure. Among patients with prior MI, an 80% risk reduction was observed.
Kostis
J B
JB
Department of Medicine, Center for Disease Management and Clinical Outcomes, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA. kostis@umdnj.edu
Davis
B R
BR
Cutler
J
J
Grimm
R H
RH
Berge
K G
KG
Cohen
J D
JD
Lacy
C R
CR
Perry
H M
HM
Blaufox
M D
MD
Wassertheil-Smoller
S
S
Black
H R
HR
Schron
E
E
Berkson
D M
DM
Curb
J D
JD
Smith
W M
WM
McDonald
R
R
Applegate
W B
WB
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D002752:Chlorthalidone / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D016019:Survival Analysis; D013599:Systole
D000959:Antihypertensive Agents; D004232:Diuretics; D001262:Atenolol; D002752:Chlorthalidone