The effects of delayed BP lowering treatment on long-term all-cause and CVD mortality did not vary with baseline risk of CVD .
The review showed no clinical ly adverse ‘ legacy effect ’ on mortality or major CVD event from not treating middle-aged adults at a systolic BP threshold of 140 mmHg or over .
Although these studies are non-r and omised post-hoc analyses , they may allay concerns that early treatment of elevated systolic BP is necessary to prevent CVD events in primary prevention population
To investigate if there is evidence for a ‘ legacy effect ’ for blood pressure ( BP ) lowering treatment , that is , worse health outcomes from not initiating drug treatment at a systolic BP threshold of 140 mmHg in middle-age adults .
Association between chlorthalidone treatment of systolic hypertension and long-term survival.
CONTEXT In the Systolic Hypertension in the Elderly Program ( SHEP ) trial , conducted between 1985 and 1990 , antihypertensive therapy with chlorthalidone-based stepped-care therapy result ed in a lower rate of cardiovascular events than placebo but effects on mortality were not significant . OBJECTIVE To study the gain in life expectancy of participants r and omized to active therapy at the 22-year follow-up . DESIGN , SETTING , AND PARTICIPANTS A National Death Index ascertainment of death in the long-term follow-up of a r and omized , placebo-controlled , clinical trial ( SHEP ) of patients aged 60 years or older with isolated systolic hypertension . Recruitment was between March 1 , 1985 , and January 15 , 1988 . After the end of a 4.5-year r and omized phase of the SHEP trial , all participants were advised to receive active therapy .  The time interval between the beginning of recruitment and the ascertainment of death by National Death Index ( December 31 , 2006 ) was approximately 22 years ( 21 years 10 months ) . MAIN OUTCOME MEASURES Cardiovascular death and all-cause mortality . RESULTS At the 22-year follow-up , life expectancy gain , expressed as the area between active ( n = 2365 ) and placebo ( n = 2371 ) survival curves , was 105 days ( 95 % CI , -39 to 242 ; P = .07 ) for all-cause mortality and 158 days ( 95 % CI , 36 - 287 ; P = .009 ) for cardiovascular death . Each month of active treatment was therefore associated with approximately 1 day extension in life expectancy . The active treatment group had higher survival free from cardiovascular death vs the placebo group ( hazard ratio [ HR ] , 0.89 ; 95 % CI , 0.80 - 0.99 ; P = .03 ) but similar survival for all-cause mortality ( HR , 0.97 ; 95 % CI , 0.90 - 1.04 ; P = .42 ) . There were 1416 deaths ( 59.9 % ) in the active treatment group and 1435 deaths ( 60.5 % ) in the placebo group ( log-rank P = .38 , Wilcoxon P = .24 ) . Cardiovascular death was lower in the active treatment group ( 669 deaths [ 28.3 % ] ) vs the placebo group ( 735 deaths [ 31.0 % ] ; log-rank P = .03 , Wilcoxon P = .02 ) . Time to 70th percentile survival was 0.56 years ( 95 % CI , -0.14 to 1.23 ) longer in the active treatment group vs the placebo group ( 11.53 vs 10.98 years ; P = .03 ) for all-cause mortality and 1.41 years ( 95 % CI , 0.34 - 2.61 ; 17.81 vs 16.39 years ; P = .01 ) for survival free from cardiovascular death . CONCLUSION 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 effects of delayed BP lowering treatment on long-term all-cause and CVD mortality did not vary with baseline risk of CVD .
The review showed no clinical ly adverse ‘ legacy effect ’ on mortality or major CVD event from not treating middle-aged adults at a systolic BP threshold of 140 mmHg or over .
Although these studies are non-r and omised post-hoc analyses , they may allay concerns that early treatment of elevated systolic BP is necessary to prevent CVD events in primary prevention population
To investigate if there is evidence for a ‘ legacy effect ’ for blood pressure ( BP ) lowering treatment , that is , worse health outcomes from not initiating drug treatment at a systolic BP threshold of 140 mmHg in middle-age adults .