title: Competing cardiovascular and noncardiovascular risks and longevity in the systolic hypertension in the elderly program.
abstract: We examined the effect of chlorthalidone-based stepped care on the competing risks of cardiovascular (CV) versus non-CV death in the Systolic Hypertension in the Elderly Program (SHEP). Participants were randomly assigned to chlorthalidone-based stepped-care therapy (n = 2,365) or placebo (n = 2,371) for 4.5 years, and all participants were advised to take active therapy thereafter. At the 22-year follow-up, the gain in life expectancy free from CV death in the active treatment group was 145 days (95% confidence interval [CI] 23 to 260, p = 0.012). The gain in overall life expectancy was smaller (105 days, 95% CI -39 to 242, p = 0.073) because of a 40-day (95% CI -87 to 161) decrease in survival from non-CV death. Compared with an age- and gender-matched cohort, participants had markedly higher overall life expectancy (Wilcoxon p = 0.00001) and greater chance of reaching the ages of 80 (81.3% vs 57.6%), 85 (58.1% vs 37.4%), 90 (30.5% vs 22.0%), 95 (11.9% vs 8.8%), and 100 years (3.7% vs 2.8%). In conclusion, Systolic Hypertension in the Elderly Program participants had higher overall life expectancy than actuarial controls and those randomized to active therapy had longer life expectancy free from CV death but had a small increase in the competing risk of non-CV death.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: William J
authors.initials: WJ
authors.lastname: Kostis
authors.affiliation: Department of Statistics, Rutgers University, Piscataway, New Jersey; The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Javier
authors.initials: J
authors.lastname: Cabrera
authors.affiliation: Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
authors.affiliation: The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Jerry Q
authors.initials: JQ
authors.lastname: Cheng
authors.affiliation: The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Sedjro
authors.affiliation: The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Nora M
authors.initials: NM
authors.lastname: Cosgrove
authors.affiliation: The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Swerdel
authors.affiliation: The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Deng
authors.affiliation: University of Texas Health Science Center, Houston, Texas.
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.affiliation: The Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. Electronic address: kostis@rwjms.rutgers.edu.
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology*; D002752:Chlorthalidone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D008136:Longevity / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D002752:Chlorthalidone