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Hypertension treatment correlates to long-term improvement in life expectancy
Taken from the Journal of the American Medical Association (JAMA) – by Bruce Sylvester –
Systolic hypertension patients treated in a clinical trial with the diuretic chlorthalidone for 4.5 years have achieved a significantly lower rate of death and a gain in life expectancy free from cardiovascular death about 20 years later, when compared to patients who received placebo, researchers reported in the December 21, 2011 issue of JAMA.
John B. Kostis, MD, of the UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, and colleagues evaluated long-term mortality data for participants in the Systolic Hypertension in the Elderly Programme (SHEP) trial, which was designed to evaluate the effect of antihypertensive drug treatment (chlorthalidone) on the risk of stroke in patients with isolated systolic hypertension.
Recruitment for SHEP was between March 1985 and January 1988. The interval between the beginning of recruitment and the ascertainment of death (December 2006) was approximately 22 years (21 years 10 months).
Of the 4,736 participants enrolled in the SHEP trial, 2,365 (49.9%) were randomised to active treatment therapy and 2,371 (50.1%) were randomised to placebo. The average age of participants was 72 years, 57% were women, and 14% were black.
At follow-up, 2,851 of the 4,736 randomised patients (60.2%) had died, with 1,416 deaths (59.9%) in the active treatment group and 1,435 deaths (60.5%) in the placebo group.
Life expectancy and time to the 70th percentile survival at the end of follow-up were longer for the SHEP subjects randomised to the active group compared with placebo subjects. Life expectancy gain at 22 years was 158 days for cardiovascular death and 105 days for death from all causes.
The gain in life expectancy free from cardiovascular death corresponds with one day (0.89 days) gained per month of treatment. For all-cause mortality, the gain in life expectancy from one month of antihypertensive drug treatment was estimated at a half day (0.59 days).
The investigators found that active treatment was also associated with higher survival free from cardiovascular death compared with placebo, 669 deaths [28.3%] vs. 735 deaths [31%], respectively.
“Reporting that each month of antihypertensive therapy was associated with one day prolongation of life expectancy free from cardiovascular death is a strong message that may result in increased patient adherence to drug therapy and decrease the degree of therapeutic inertia by health care providers,” the authors concluded.
