TY - JOUR T1 - Diuretic based therapy reduced CV mortality in older patients with isolated systolic hypertension and diabetes JF - Evidence Based Medicine JO - Evid Based Med SP - 75 LP - 75 DO - 10.1136/ebm.10.3.75 VL - 10 IS - 3 A2 - , Y1 - 2005/06/01 UR - http://ebm.bmj.com/content/10/3/75.abstract N2 - Kostis JB, Wilson AC, Freudenberger RS, et al. Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. Am J Cardiol 2005;95:29–35.OpenUrlCrossRefPubMedWeb of Science 
 
 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 ★★★★★★☆ 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 … ER -