title: The role of diastolic blood pressure when treating isolated systolic hypertension.
abstract: OBJECTIVE
  To assess the role of treated diastolic blood pressure (DBP) level in stroke, coronary heart disease (CHD), and cardiovascular disease (CVD) in patients with isolated systolic hypertension (ISH).
  
  
  METHODS
  An analysis of the 4736 participants in the Systolic Hypertension in the Elderly Program (SHEP) was undertaken. The SHEP was a randomized multicenter double-blind outpatient clinical trial of the impact of treating ISH in men and women aged 60 years and older.
  
  
  METHODS
  Cox proportional hazards regression analysis, with DBP and systolic blood pressure (SBP) as time-dependent covariables.
  
  
  RESULTS
  After adjustment for the baseline risk factors of race (black vs other), sex, use of antihypertensive medication before the study, a composite variable (diabetes, previous heart attack, or stroke), age, and smoking history (ever vs never) and adjustment for the SBP as a time-dependent variable, we found, for the active treatment group only, that a decrease of 5 mm Hg in DBP increased the risk for stroke (relative risk, [RR], 1.14; 95% confidence interval [CI], 1.05-1.22), for CHD (RR, 1.08; 95% CI, 1.00-1.16), and for CVD (RR, 1.11; 95% CI, 1.05-1.16).
  
  
  CONCLUSIONS
  Some patients with ISH may be treated to a level that uncovers subclinical disease, and some may be overtreated. Further studies need to determine whether excessively low DBP can be prevented by more careful titration of antihypertensive therapy while maintaining SBP control. It is reassuring that patients receiving treatment for ISH never perform worse than patients receiving placebo in terms of CVD events.
authors.affiliation: Department of Preventive Medicine, University of Tennessee, Memphis 38105, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Somes
authors.forename: M
authors.initials: M
authors.lastname: Pahor
authors.forename: R I
authors.initials: RI
authors.lastname: Shorr
authors.forename: W C
authors.initials: WC
authors.lastname: Cushman
authors.forename: W B
authors.initials: WB
authors.lastname: Applegate
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000503:physiopathology; D003327:Coronary Disease / Q000209:etiology* / Q000503:physiopathology; D003971:Diastole; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013599:Systole
chemical_list: D000959:Antihypertensive Agents