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Evid Based Med 17:183-184 doi:10.1136/ebmed-2012-100677
  • Therapeutics

The legacy effect: 4.5 years of a chlorthalidone-based antihypertensive regimen reduces cardiovascular mortality and prolongs cardiovascular disease-free survival at 22 years for older patients with isolated systolic hypertension

  1. Gerald William Smetana
  1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to: Gerald W Smetana
    Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Shapiro 621D, 330 Brookline Ave., Boston, MA 02215, USA; gsmetana{at}bidmc.harvard.edu

Commentary on:

Context

Due to decreased vascular compliance, hypertension in older patients is commonly limited to systolic blood pressure; pulse pressures are wider than for younger patients. Decades ago, physicians commonly withheld treatment for older patients with isolated systolic hypertension due to a belief that this was a ‘normal’ or acceptable consequence of ageing that carried no excess morbidity. Since the early 1990's, multiple large-scale treatment trials disproved this hypothesis. These included the Syst-Eur and Syst-China trials of nitrendipine, and the MRC(Medical Research Council) trial of hydrochlorothiazide plus amiloride.

One of the largest and most influential trials was the Systolic Hypertension in the Elderly Program (SHEP) study.1 In this trial, eligible patients were above the age of 60 (mean 71.6 years), had no pre-existing …

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