Stepped-care antihypertensive treatment based on low-dose chlorthalidone reduced the risk of fatal or nonfatal heart failure compared to placebo (RR 0.51; 95% CI 0.37-0.71; P<.001).
RCT (n=4,736)
double-blind
randomized
Yes
Does stepped-care antihypertensive drug therapy based on chlorthalidone reduce fatal and nonfatal heart failure in older persons with isolated systolic hypertension?
In older persons with isolated systolic hypertension, diuretic-based stepped-care antihypertensive treatment significantly reduces the risk of developing fatal and nonfatal heart failure.
Effect estimate: RR 0.51 (95% CI 0.37-0.71)
Absolute Event Rate: 2.33% vs 4.43%
p-value: p=<.001
Context. —Heart failure is often preceded by isolated systolic hypertension, but the effectiveness of antihypertensive treatment in preventing heart failure is not known. Objective. —To assess the effect of diuretic-based antihypertensive stepped-care treatment on the occurrence of heart failure in older persons with isolated systolic hypertension. Design. —Analysis of data from a multicenter, randomized, double-blind, placebo-controlled clinical trial. Participants. —A total of 4736 persons aged 60 years and older with systolic blood pressure between 160 and 219 mm Hg and diastolic blood pressure below 90 mm Hg who participated in the Systolic Hypertension in the Elderly Program (SHEP). Intervention. —Stepped-care antihypertensive drug therapy, in which the step 1 drug is chlorthalidone (12.5-25 mg) or matching placebo, and the step 2 drug is atenolol (25-50 mg) or matching placebo. Main Outcome Measures. —Fatal and nonfatal heart failure. Results. —During an average of 4.5 years of follow-up, fatal or nonfatal heart failure occurred in 55 of 2365 patients randomized to active therapy and 105 of the 2371 patients randomized to placebo (relative risk RR, 0.51; 95% confidence interval CI, 0.37-0.71;PP=.002; NNT, 15). Older patients, men, and those with higher systolic blood pressure or a history of or electrocardiographic evidence of MI at baseline had higher risk of developing heart failure. Conclusion. —In older persons with isolated systolic hypertension, stepped-care treatment based on low-dose chlorthalidone exerted a strong protective effect in preventing heart failure. Among patients with prior MI, an 80% risk reduction was observed.
John B. Kostis (Wed,) conducted a rct in isolated systolic hypertension (n=4,736). Stepped-care antihypertensive drug therapy (chlorthalidone, atenolol) vs. placebo was evaluated on Fatal and nonfatal heart failure (RR 0.51, 95% CI 0.37-0.71, p=<.001). Stepped-care antihypertensive treatment based on low-dose chlorthalidone reduced the risk of fatal or nonfatal heart failure compared to placebo (RR 0.51; 95% CI 0.37-0.71; P<.001).