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Q In older patients with isolated systolic hypertension (ISH) with or without diabetes, what is the long term effectiveness of a diuretic based, stepped care antihypertensive therapy compared with placebo?
Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Cardiology ★★★★★☆☆ Endocrine ★★★★★★☆
METHODS
Design:
randomised placebo controlled trial (Systolic Hypertension in the Elderly Program [SHEP]).
Allocation:
concealed.*
Blinding:
blinded {clinicians, patients, data collectors, outcome assessors, and data analysts*}†.
Follow-up period:
median 14.3 years.
Setting:
{16 clinical centres in the US}†.
Patients:
4736 patients ⩾60 years of age who had ISH (systolic blood pressure [BP] 160 to 219 mm Hg and diastolic BP <90 mm Hg). Patients with type 1 diabetes or those who required diuretic therapy were excluded.
Intervention:
stepped care therapy with chlorthalidone, 12.5 to 25.0 mg/day (n = 2363) or placebo (n = 369) to achieve a systolic BP decrease of ⩾20 mm Hg to <160 mm Hg. If the goal BP was not reached, atenolol or …