Key Points
- To evaluate the 11- to 14-year reduction in cardiovascular events associated with treating isolated systolic hypertension and to assess the impact of baseline subclinical atherosclerosis.
- Followed older adults from the Pittsburgh SHEP cohort randomized to active treatment (n = 135) or placebo (n = 133), alongside a normotensive control cohort (n = 187), for 11 to 14 years.
- Assessed baseline subclinical atherosclerosis using carotid ultrasound and ankle blood pressure measurements.
- Fourteen-year Kaplan-Meier event rates were 58% for the active treatment group versus 79% for placebo (P = .001), while 11-year rates were 35% in controls, 47% in active treatment, and 65% in placebo.
- Compared with normotensive controls, the relative risk of an event was 1.6 (95% CI, 1.1-2.4) for active treatment and 3.0 (95% CI, 2.1-4.4) for placebo.
- Among individuals without baseline clinical or subclinical disease, 10-year event rates were 29% for active treatment, 27% for controls, and 69% for placebo.
Structured PICO
Does active treatment of isolated systolic hypertension reduce death or cardiovascular events in older adults?
PPopulation455 older adults from the Pittsburgh SHEP cohort, including patients with isolated systolic hypertension (n=268) and normotensive controls (n=187).
IInterventionActive antihypertensive treatment for isolated systolic hypertension
CComparatorPlacebo (n=133) and normotensive controls (n=187)
OOutcomeDeath or cardiovascular event rates at 11 to 14 yearscomposite
Treatment of isolated systolic hypertension in older adults significantly reduces long-term cardiovascular event rates, particularly when initiated before advanced atherosclerosis develops.