Isolated systolic hypertension (ISH) is a strong predictor of stroke in older adults, yet treating just ten to thirteen individuals prevents one disabling stroke, a low number to treat to prevent harm. The use of one of the older antihypertensive agents, hydrochlorothiazide (HCTZ) or the “pink pill”, is known to be an excellent first-line agent at lowering dangerously high systolic blood pressures.
In published results from the SHEP trial (Systolic Hypertension in the Elderly Program), as reported in Endocrine Today in January 2012, stepped-care therapy over 4.5 years with chlorthalidone, another older thiazide-type diuretic, lowered mortality rates and increased life-expectancy in older adults with ISH. The trial was randomized, placebo-controlled, and went from 1985 to 1990. After 22 years of follow-up, 59.9% of the active treatment group (N=2365) died whereas 60.5% in the placebo group (N=2371). Death from stroke in the treatment group occurred in 4.6% versus 5.6% in the placebo group. Life expectancy gain in the treatment group was 158 days for cardiovascular death and 105 days for all cause death. The researchers also found that active treatment was associated with higher survival free from cardiovascular death versus the placebo group (28.3 vs. 31%).