Morbidity, Mortality, and Antihypertensive Treatment Effects by Extent of Atherosclerosis in Older Adults With Isolated Systolic Hypertension

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Abstract
Background and Purpose 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. Methods 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. Results 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 ...