Systemic hypertensionLong-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes
Section snippets
Methods
The SHEP was a placebo-controlled, double-blind, randomized, multicenter clinical trial that tested the efficacy of diuretic-based stepped-care antihypertensive management of isolated systolic hypertension in subjects ≥60 years of age.4, 8 The major inclusion criterion was the presence of isolated systolic hypertension, which was defined as a systolic blood pressure of 160 to 219 mm Hg with a diastolic blood pressure <90 mm Hg. Patients who had insulin-dependent diabetes mellitus and those who
Results
Baseline characteristics of the active treatment and placebo groups at randomization have been previously reported.4, 18 Mean age was 71.6 ± 6.7 years, 58% were women, 14% were African-American, 16.9% had diabetes, 4.9% had a history of myocardial infarction, 49.8% were current or previous smokers, and mean blood pressures were 170.3 ± 9.4 mm Hg (systolic) and 77.0 ± 8.0 mm Hg (diastolic).
Discussion
This long-term study of older patients who had isolated systolic hypertension yielded 3 conclusions of clinical significance. First, chlorthalidone-based antihypertensive therapy was associated with a significantly lower rate of CV mortality during long-term follow-up (14.3 years). This was not observed during the double-blind phase of the study. Second, in contrast to diabetes present at baseline, diabetes diagnosed during diuretic therapy was rather mild and not associated with a significant
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Cardiovascular drugs promoting diabetes
2019, Archives des Maladies du Coeur et des Vaisseaux - Pratique2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
2018, Journal of the American Society of Hypertension2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
2018, Journal of the American College of CardiologyRevisiting ASCOT 16 years later
2018, The LancetLong-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial
2018, The LancetCitation Excerpt :In-trial benefits that were apparent with the use of chlorthalidone versus amlodipine and lisinopril, respectively, were no longer evident in the long-term follow-up. In long-term follow-up of trials in patients with hypertension11 that compared active treatment with placebo, and in which blood pressure differences were associated with substantial reductions in cardiovascular events, a legacy or carryover effect has been seen in the post-trial period,26–29 with long-term reductions—on average 9%—in mortality in the groups previously receiving active treatment.11 However, in ASCOT, which compared different active (alternative) treatment strategies,16 the long-term benefits associated with the amlodipine-based regimen could not be attributed to earlier differences in blood pressures during the trial.30
This study was supported in part by contracts with the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and the National Institute on Aging, Bethesda, Maryland; and a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey.