Part 9: Behavioral Characteristics

Presented are the baseline behavioral characteristics of the randomized Systolic Hypertension in the Elderly Program (SHEP) participants. The main purpose of the SHEP study is to evaluate the effects of treating isolated systolic hypertension (ISH) on mortality and morbidity in older persons. There are two behavioral end points in the study: dementia and depression. However, it will not be possible to fully determine whether to treat ISH without evaluating the impact of the diagnosis and treatment of this condition on quality of life. Factors used in SHEP to evaluate quality of life include measures of cognitive status, affective state, ability to perform activities of daily living, satisfaction with life in general, and subjective well-being. In addition, participants' social networks are assessed because they may impact quality of life and ability to cope with adverse life circumstances. Several studies have reported adverse effects of hypertension on behavioral tasks, such as response speed, Wechsler Adult Intelligence Scale performance, and memory function. However, findings have had limited applicability to SHEP because they have usually included only persons with diastolic hypertension, have not concentrated primarily on an elderly population, and have not been well controlled in regard to effects of medication. SHEP presents an opportunity to evaluate the effects of treating ISH on the quality of life of elderly participants as well as on the designated end points of depression and dementia. Therefore, the behavioral assessment in SHEP was designed to answer the following questions. First, for men and women 60 years old or older who have ISH, what is the baseline quality of life in terms of cognitive, affective, and functional status? Second, will participants in the control group become more cognitively impaired as a result of sustained hypertension or incremental effects of small infarcts than those who are treated? Will the control group be more depressed or disabled as a result of the symptoms of hypertension than the treated group? Third, what are the effects of lowering SBP in older persons? Will the treated group show improvement in behavioral measures of quality of life when blood pressure is lowered, or do elderly people require a certain level of SBP to maintain adequate cognitive functioning? Finally, what are the side effects of antihypertensive medication on behavior, and what impact will long-term medication use have on quality of life? Behavioral evaluation measures were selected that have been validated with populations of older persons and are sensitive to the effects of either hypertension itself or antihypertensive medication. An attempt was made to keep the behavioral components comparable with those used in the SHEP preliminary study (SHEP-PS) and other current studies, such as the Established Populations for Epidemiological Studies of the Elderly (EPESE) Program. * In addition, measures were selected that would provide information on a broad spectrum of functions that may impact on quality of life in older individuals without placing an undue burden on the participant. Finally, because these measures are being repeatedly administered in a longitudinal design, they must vary in their degTee of difficulty in a practical way that will optimize the detection of either improvement or deterioration of function over time.