Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension
The Systolic Hypertension in the Elderly Program (SHEP) demonstrated a significant reduction in stroke and coronary event rates among participants randomly assigned to active blood pressure treatment. Selected participants were evaluated for peripheral atherosclerosis and followed up for cardiovascu...
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| Veröffentlicht in: | Stroke (1970) 1995-08, Vol.26 (8), p.1319-1324 |
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| container_title | Stroke (1970) |
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| creator | SUTTON-TYRRELL, K ALCORN, H. G HERZOG, H KELSEY, S. F KULLER, L. H |
| description | The Systolic Hypertension in the Elderly Program (SHEP) demonstrated a significant reduction in stroke and coronary event rates among participants randomly assigned to active blood pressure treatment. Selected participants were evaluated for peripheral atherosclerosis and followed up for cardiovascular events beyond the end of the SHEP trial. Antihypertensive treatment effects were evaluated based on the presence or absence of clinical or subclinical atherosclerosis.
As an ancillary study to SHEP, 190 participants at the Pittsburgh center were evaluated for peripheral atherosclerosis, defined as either an internal carotid stenosis (by duplex scan) or lower extremity arterial disease (identified by ankle blood pressure). Participants were subsequently followed up for cardiovascular events.
Estimates of 4-year mortality rates were 4.8% for participants with no atherosclerosis, 16.7% for those with subclinical atherosclerosis, and 23% among those with clinical evidence of atherosclerosis (P < .001). Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and 58.3% for the three groups, respectively (P < .001). Differences remained significant after adjustment for age, sex, treatment assignment, smoking, and high-density lipoprotein cholesterol. Individuals assigned to placebo at the beginning of SHEP had higher cardiovascular event rates than individuals assigned to active treatment (P = .011), with the most striking difference 3 or more years after the end of the SHEP trial. When this analysis was stratified by the presence or absence of detectable atherosclerosis, the absolute treatment effect was largest among those with evidence of disease.
Individuals with systolic hypertension and evidence of peripheral atherosclerosis are at high risk for cardiovascular events. Targeting this group for antihypertensive therapy would result in the prevention of a large number of cardiovascular events. |
| doi_str_mv | 10.1161/01.STR.26.8.1319 |
| format | Article |
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As an ancillary study to SHEP, 190 participants at the Pittsburgh center were evaluated for peripheral atherosclerosis, defined as either an internal carotid stenosis (by duplex scan) or lower extremity arterial disease (identified by ankle blood pressure). Participants were subsequently followed up for cardiovascular events.
Estimates of 4-year mortality rates were 4.8% for participants with no atherosclerosis, 16.7% for those with subclinical atherosclerosis, and 23% among those with clinical evidence of atherosclerosis (P < .001). Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and 58.3% for the three groups, respectively (P < .001). Differences remained significant after adjustment for age, sex, treatment assignment, smoking, and high-density lipoprotein cholesterol. Individuals assigned to placebo at the beginning of SHEP had higher cardiovascular event rates than individuals assigned to active treatment (P = .011), with the most striking difference 3 or more years after the end of the SHEP trial. When this analysis was stratified by the presence or absence of detectable atherosclerosis, the absolute treatment effect was largest among those with evidence of disease.
Individuals with systolic hypertension and evidence of peripheral atherosclerosis are at high risk for cardiovascular events. Targeting this group for antihypertensive therapy would result in the prevention of a large number of cardiovascular events.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.26.8.1319</identifier><identifier>PMID: 7631329</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Antihypertensive Agents - therapeutic use ; Arterial hypertension. Arterial hypotension ; Arteriosclerosis - complications ; Arteriosclerosis - drug therapy ; Arteriosclerosis - epidemiology ; Arteriosclerosis - mortality ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Cohort Studies ; Follow-Up Studies ; Humans ; Hypertension - complications ; Hypertension - drug therapy ; Hypertension - epidemiology ; Hypertension - mortality ; Medical sciences ; Morbidity ; Risk Factors ; Survival Analysis ; United States</subject><ispartof>Stroke (1970), 1995-08, Vol.26 (8), p.1319-1324</ispartof><rights>1995 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Aug 1995</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-2dbc9146c48c30854b2113631aa00afc93fbf7cf3c74e9d56a8901c0e2f488593</citedby><cites>FETCH-LOGICAL-c433t-2dbc9146c48c30854b2113631aa00afc93fbf7cf3c74e9d56a8901c0e2f488593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,3691,27933,27934</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3625414$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7631329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SUTTON-TYRRELL, K</creatorcontrib><creatorcontrib>ALCORN, H. G</creatorcontrib><creatorcontrib>HERZOG, H</creatorcontrib><creatorcontrib>KELSEY, S. F</creatorcontrib><creatorcontrib>KULLER, L. H</creatorcontrib><title>Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>The Systolic Hypertension in the Elderly Program (SHEP) demonstrated a significant reduction in stroke and coronary event rates among participants randomly assigned to active blood pressure treatment. Selected participants were evaluated for peripheral atherosclerosis and followed up for cardiovascular events beyond the end of the SHEP trial. Antihypertensive treatment effects were evaluated based on the presence or absence of clinical or subclinical atherosclerosis.
As an ancillary study to SHEP, 190 participants at the Pittsburgh center were evaluated for peripheral atherosclerosis, defined as either an internal carotid stenosis (by duplex scan) or lower extremity arterial disease (identified by ankle blood pressure). Participants were subsequently followed up for cardiovascular events.
Estimates of 4-year mortality rates were 4.8% for participants with no atherosclerosis, 16.7% for those with subclinical atherosclerosis, and 23% among those with clinical evidence of atherosclerosis (P < .001). Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and 58.3% for the three groups, respectively (P < .001). Differences remained significant after adjustment for age, sex, treatment assignment, smoking, and high-density lipoprotein cholesterol. Individuals assigned to placebo at the beginning of SHEP had higher cardiovascular event rates than individuals assigned to active treatment (P = .011), with the most striking difference 3 or more years after the end of the SHEP trial. When this analysis was stratified by the presence or absence of detectable atherosclerosis, the absolute treatment effect was largest among those with evidence of disease.
Individuals with systolic hypertension and evidence of peripheral atherosclerosis are at high risk for cardiovascular events. Targeting this group for antihypertensive therapy would result in the prevention of a large number of cardiovascular events.</description><subject>Aged</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Arteriosclerosis - complications</subject><subject>Arteriosclerosis - drug therapy</subject><subject>Arteriosclerosis - epidemiology</subject><subject>Arteriosclerosis - mortality</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Cohort Studies</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - epidemiology</subject><subject>Hypertension - mortality</subject><subject>Medical sciences</subject><subject>Morbidity</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><subject>United States</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU2LFDEQhoMo6-zq3YsQRDzZbb463TnK4hesCLqeQzpdYbKkO2OSXu0f4X824w4reEglVD1VeYsXoWeUtJRK-obQ9tv115bJdmgpp-oB2tGOiUZINjxEO0K4aphQ6jE6z_mGEML40J2hs15yypnaod-fYxr95Mv2Gs8xFRP-Ps0y1VP8fjtAKrBkfwu4JDBlhqVgcA5syXjcMPwqx0x02JQ9pJhtOEafsV9wDBMkbKY1VPinL3vscwymwITzlksM3uJ_X8TlCXrkTMjw9HRfoO_v311ffmyuvnz4dPn2qrGC89KwabSKCmnFYDkZOjEySnldyRhCjLOKu9H11nHbC1BTJ82gCLUEmBPD0Cl-gV7dzT2k-GOFXPTss4UQzAJxzbrvBZeMigq--A-8iWtaqjZNVaWk4KxC5A6ydfGcwOlD8rNJm6ZEH23ShOpqk2ZSD_poU215fpq7jjNM9w0nX2r95alusjXBJbNYn--xKq4TVd4fHRGd6g</recordid><startdate>19950801</startdate><enddate>19950801</enddate><creator>SUTTON-TYRRELL, K</creator><creator>ALCORN, H. 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H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-2dbc9146c48c30854b2113631aa00afc93fbf7cf3c74e9d56a8901c0e2f488593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Aged</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Arteriosclerosis - complications</topic><topic>Arteriosclerosis - drug therapy</topic><topic>Arteriosclerosis - epidemiology</topic><topic>Arteriosclerosis - mortality</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Cohort Studies</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - epidemiology</topic><topic>Hypertension - mortality</topic><topic>Medical sciences</topic><topic>Morbidity</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SUTTON-TYRRELL, K</creatorcontrib><creatorcontrib>ALCORN, H. G</creatorcontrib><creatorcontrib>HERZOG, H</creatorcontrib><creatorcontrib>KELSEY, S. F</creatorcontrib><creatorcontrib>KULLER, L. 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H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>1995-08-01</date><risdate>1995</risdate><volume>26</volume><issue>8</issue><spage>1319</spage><epage>1324</epage><pages>1319-1324</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>The Systolic Hypertension in the Elderly Program (SHEP) demonstrated a significant reduction in stroke and coronary event rates among participants randomly assigned to active blood pressure treatment. Selected participants were evaluated for peripheral atherosclerosis and followed up for cardiovascular events beyond the end of the SHEP trial. Antihypertensive treatment effects were evaluated based on the presence or absence of clinical or subclinical atherosclerosis.
As an ancillary study to SHEP, 190 participants at the Pittsburgh center were evaluated for peripheral atherosclerosis, defined as either an internal carotid stenosis (by duplex scan) or lower extremity arterial disease (identified by ankle blood pressure). Participants were subsequently followed up for cardiovascular events.
Estimates of 4-year mortality rates were 4.8% for participants with no atherosclerosis, 16.7% for those with subclinical atherosclerosis, and 23% among those with clinical evidence of atherosclerosis (P < .001). Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and 58.3% for the three groups, respectively (P < .001). Differences remained significant after adjustment for age, sex, treatment assignment, smoking, and high-density lipoprotein cholesterol. Individuals assigned to placebo at the beginning of SHEP had higher cardiovascular event rates than individuals assigned to active treatment (P = .011), with the most striking difference 3 or more years after the end of the SHEP trial. When this analysis was stratified by the presence or absence of detectable atherosclerosis, the absolute treatment effect was largest among those with evidence of disease.
Individuals with systolic hypertension and evidence of peripheral atherosclerosis are at high risk for cardiovascular events. Targeting this group for antihypertensive therapy would result in the prevention of a large number of cardiovascular events.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>7631329</pmid><doi>10.1161/01.STR.26.8.1319</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Antihypertensive Agents - therapeutic use Arterial hypertension. Arterial hypotension Arteriosclerosis - complications Arteriosclerosis - drug therapy Arteriosclerosis - epidemiology Arteriosclerosis - mortality Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Cohort Studies Follow-Up Studies Humans Hypertension - complications Hypertension - drug therapy Hypertension - epidemiology Hypertension - mortality Medical sciences Morbidity Risk Factors Survival Analysis United States |
| title | Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension |
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