Long-term fatal outcomes in subjects with stroke or transient ischemic attack: fourteen-year follow-up of the systolic hypertension in the elderly program.
OBJECTIVE
Epidemiologic studies have demonstrated that hypertension increases the risk of stroke, and clinical trials have shown that antihypertensive therapy reduces this risk. Incident stroke was significantly decreased by treatment in the Systolic Hypertension in Elderly Program (SHEP) Trial, but the reduction in fatal events was not statistically significant.


METHODS
Vital status was determined for 4736 SHEP participants by matching to the National Death Index. We assessed the impact of antihypertensive treatment, stroke, and transient ischemic attacks (TIAs) during SHEP on long-term (mean, 14.3 years) mortality.


RESULTS
Treatment with a chlorthalidone-based antihypertensive regimen significantly reduced the risk of cardiovascular death (adjusted relative risk [RR]=0.86; 95% CI, 0.76 to 0.98, P=0.026) in the SHEP cohort without a significant (P=0.39) interaction with stroke status. Patients who sustained a stroke during SHEP had significantly higher all-cause mortality at the 14.3-year mean follow-up: 65.6% compared with 40.6% among those free of stroke or TIA (adjusted RR=1.97; 95% CI, 1.67 to 2.33). They also were at higher risk for cardiovascular death (RR=2.00; 95% CI, 1.58 to 2.53) and stroke death (RR=2.94; 95% CI, 1.87 to 4.64). TIA was not significantly associated with increased total mortality (RR=1.13; 95% CI, 0.88 to 1.44), cardiovascular death (RR=1.30; 95% CI, 0.94 to 1.81), or stroke death (RR=1.76; 95% CI, 0.95 to 3.26).


CONCLUSIONS
In SHEP, chlorthalidone-based treatment reduced the risk of cardiovascular death after 14 years of extended follow-up. Nearly two thirds of elderly persons with isolated systolic hypertension who experienced stroke died within 14 years.
Patel
Alpesh B
AB
Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood Johnson Pl, PO Box 19, New Brunswick, NJ 08903-0019, USA.
Kostis
John B
JB
Wilson
Alan C
AC
Shea
Michael L
ML
Pressel
Sara L
SL
Davis
Barry R
BR
D000328:Adult; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002423:Cause of Death; D002752:Chlorthalidone / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality*; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*
D000959:Antihypertensive Agents; D002752:Chlorthalidone