December 1, 1995American Journal of Hypertension
Effect of atenolol and reserpine on selected events in the systolic hypertension in the elderly program (SHEP)*
Why the study?
Does the addition of atenolol or reserpine to chlorthalidone reduce strokes, CHD, CVD, and mortality in elderly patients with isolated systolic hypertension?
Population
4,736 persons aged 60 years and older with isolated systolic hypertension, average baseline SBP/DBP 170/77…
Comparison
Chlorthalidone with step-up to atenolol or… vs Placebo
Design
RCT, randomized
Follow-up
4.5 years average
Authors
Discussion
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Implication
Chlorthalidone monotherapy suffices for CHD risk reduction in elderly ISH; confirms no incremental benefit from atenolol or reserpine addition.
Structured PICO
Does the addition of atenolol or reserpine to chlorthalidone reduce strokes, CHD, CVD, and mortality in elderly patients with isolated systolic hypertension?
P
Population
4,736 persons aged 60 years and older with isolated systolic hypertension, average baseline SBP/DBP 170/77 mm Hg
I
Intervention
Chlorthalidone (12.5-25 mg/day) with step-up to atenolol (25-50 mg/day) or reserpine (0.05-0.10 mg/day) if needed
C
Comparator
Placebo
O
Outcome
Incidence of strokes, coronary heart disease (CHD), cardiovascular disease (CVD), and mortalityhard clinical
The beneficial effects of blood pressure lowering in the SHEP trial were primarily driven by low-dose chlorthalidone, with no additional independent benefits identified from step-up therapy with atenolol or reserpine.
Limitations
- A greater number of patients might have been necessary to adequately evaluate potential differential effects of these drugs, especially for reserpine.
Cite This Study
Kostis et al. (1995) studied this question.