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Competing cardiovascular and noncardiovascular risks and longevity in the systolic hypertension in the elderly

William J Kostis1, Javier Cabrera2, Franz H Messerli3

  • 1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

The American Journal of Cardiology
|January 7, 2014
PubMed

Insights

Chlorthalidone-based stepped care in the Systolic Hypertension in the Elderly Program (SHEP) increased life expectancy free from cardiovascular death. However, it also led to a small increase in non-cardiovascular death, impacting overall life expectancy gains.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Elderly individuals with isolated systolic hypertension face competing risks of cardiovascular (CV) and non-CV death.
  • The Systolic Hypertension in the Elderly Program (SHEP) investigated chlorthalidone-based stepped-care therapy for this population.

Purpose of the Study:

  • To evaluate the long-term effects of chlorthalidone-based stepped-care therapy on competing risks of CV versus non-CV death.
  • To assess the impact of SHEP intervention on overall and CV-death-free life expectancy over 22 years.

Main Methods:

  • Randomized controlled trial comparing chlorthalidone-based stepped-care therapy to placebo in elderly individuals with systolic hypertension.
  • Long-term follow-up (22 years) assessing cardiovascular and non-cardiovascular mortality and life expectancy.

Main Results:

  • Active treatment group gained 145 days in CV-death-free life expectancy at 22-year follow-up (p=0.012).
  • Overall life expectancy gain was smaller (105 days, p=0.073) due to a 40-day decrease in non-CV survival.
  • SHEP participants demonstrated significantly higher overall life expectancy and longevity compared to age- and gender-matched controls.

Conclusions:

  • Chlorthalidone-based therapy in SHEP significantly extended life expectancy free from cardiovascular death.
  • A small increase in non-CV death was observed, slightly diminishing the overall life expectancy benefit.
  • The SHEP intervention resulted in improved longevity and higher overall life expectancy in the elderly population studied.

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