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Titolo:
Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke - The Systolic Hypertension in the Elderly Program (SHEP)
Autore:
Perry, HM; Davis, BR; Price, TR; Applegate, WB; Fields, WS; Guralnik, JM; Kuller, L; Pressel, S; Stamler, J; Probstfield, JL;
Indirizzi:
Washington Univ, Dept Med, St Louis, MO 63110 USA Washington Univ St Louis MO USA 63110 v, Dept Med, St Louis, MO 63110 USA Univ Texas, Hlth Sci Ctr, Sch Publ Hlth, Houston, TX USA Univ Texas Houston TX USA , Hlth Sci Ctr, Sch Publ Hlth, Houston, TX USA Univ Maryland, Sch Med, Dept Neurol, Baltimore, MD 21201 USA Univ Maryland Baltimore MD USA 21201 Dept Neurol, Baltimore, MD 21201 USA Wake Forest Univ, Dept Med, Winston Salem, NC 27109 USA Wake Forest Univ Winston Salem NC USA 27109 , Winston Salem, NC 27109 USA NIA, Bethesda, MD 20892 USA NIA Bethesda MD USA 20892NIA, Bethesda, MD 20892 USA Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA Univ PittsburghPittsburgh PA USA 15261 idemiol, Pittsburgh, PA 15261 USA Northwestern Univ, Sch Med, Dept Prevent Med, Chicago, IL USA NorthwesternUniv Chicago IL USA Med, Dept Prevent Med, Chicago, IL USA Univ Washington, Dept Med, Seattle, WA USA Univ Washington Seattle WA USA niv Washington, Dept Med, Seattle, WA USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 4, volume: 284, anno: 2000,
pagine: 465 - 471
SICI:
0098-7484(20000726)284:4<465:EOTISH>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
HEMORRHAGE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
21
Recensione:
Indirizzi per estratti:
Indirizzo: Perry, HM Washington Univ, Dept Med, Box 8048,660 S Euclid Ave, St Louis, MO 63110 USA Washington Univ Box 8048,660 S Euclid Ave St Louis MO USA 63110
Citazione:
H.M. Perry et al., "Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke - The Systolic Hypertension in the Elderly Program (SHEP)", J AM MED A, 284(4), 2000, pp. 465-471

Abstract

Context The Systolic Hypertension in the Elderly Program (SHEP) demonstrated that treating isolated systolic hypertension in older patients decreasedincidence of total stroke, but whether all types of stroke were reduced was not evaluated. Objective To investigate antihypertensive drug treatment effects on incidence of stroke by type and subtype, timing of strokes, case-fatality rates, stroke residual effects, and relationship of attained systolic blood pressure to stroke incidence. Design The SHEP study, a randomized, double-blind, placebo-controlled trial began March 1, 1985, and had an average follow-up of 4.5 years. Setting and Participants A total of 4736 men and women aged 60 years or older with isolated systolic hypertension at 16 clinical centers in the United States. Interventions Patients were randomly assigned to receive treatment with 12.5 mg/d of chlorthalidone (step 1); either 25 mg/d of atenolol or 0.05 mg/dof reserpine (step 2) could be added (n = 2365); or placebo (n = 2371). Main Outcome Measures Occurrence, type and subtype, and timing of first strokes and stroke fatalities; and change in stroke incidence for participants (whether in active treatment or placebo groups) reaching study-specific systolic blood pressure goal (decrease of at least 20 mm Hg from baseline tobelow 160 mm Hg) compared with participants not reaching goal. Results A total of 85 and 132 participants in the active treatment and placebo groups, respectively, had ischemic strokes (adjusted relative risk [RR], 0.63; 95% confidence interval [CI], 0.48-0.82); 9 and 19 had hemorrhagicstrokes (adjusted RR, 0.46; 95% CI, 0.21-1.02); and 9 and 8 had strokes ofunknown type (adjusted RR, 1.05; 95% CI, 0.40-2.73), respectively. Four subtypes of ischemic stroke were observed in active treatment and placebo group participants, respectively, as follows: for lacunar, n=23 and n=43 (adjusted RR, 0.53; 95% CI, 0.32-0.88); for embolic, n=9 and n=16 (adjusted RR, 0.56; 95% CI, 0.25-1.27); for atherosclerotic, n=13 and n=13 (adjusted RR, 0.99; 95% CI, 0.46-2.15); and for unknown subtype, n=40 and n=60 (adjusted RR, 0.64; 95% CI, 0.43-0.96). Treatment effect was observed within 1 year for hemorrhagic strokes but was not seen until the second year for ischemic strokes. Stroke incidence significantly decreased in participants attainingstudy-specific systolic blood pressure goals. Conclusions In this study, antihypertensive drug treatment reduced the incidence of both hemorrhagic and ischemic (including lacunar) strokes. Reduction in stroke incidence occurred when specific systolic blood pressure goals were attained.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/11/20 alle ore 10:28:20