Chlorthalidone Treatment Offers Long-Term Survival Benefits
HealthDay News— Chlorthalidone treatment for isolated systolic hypertension, among participants of the Systolic Hypertension in the Elderly Program (SHEP) trial, is associated with improved cardiovascular mortality, according to a study published in the Dec. 21 issue of the Journal of the American Medical Association.
John B. Kostis, MD, from the University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School in New Brunswick, and colleagues investigated the increase in life expectancy of 4,736 patients aged 60 years or older with isolated systolic hypertension, enrolled in the SHEP trial from 1985 to 1990. Active chlorthalidone therapy was advised to all patients following the 4.5-year randomized phase. Cardiovascular and all-cause mortality were ascertained at approximately 22 years of follow-up.
The investigators found that, at follow-up, the life expectancy gain (area between the active and placebo survival cases) was 105 days for all-cause mortality (P=0.07) and 158 days for cardiovascular death (P=0.009), representing approximately a one day extension in life expectancy with each month of active treatment. Survival, without death from cardiovascular disease, was higher in the active treatment vs. placebo groups (hazard ratio [HR]=0.89; P=0.03), whereas survival for all-cause mortality was similar (HR=0.97; P=0.42). Death occurred in 59.9% of active and 60.5% of placebo group participants (log-rank P=0.38). The active treatment group had significantly lower incidence of cardiovascular death compared with the placebo group (28.3% vs. 31%).
"In the SHEP trial, treatment of isolated systolic hypertension with chlorthalidone stepped-care therapy for 4.5 years was associated with longer life expectancy at 22 years of follow-up," the authors write.