Abstract 2388: Impact of Stroke and TIA on Long-Term Fatal Outcomes: 14-Year Follow-Up of the Systolic Hypertension in Elderly Program (SHEP)
Introduction: Incident stroke rate was significantly decreased by treatment in the Systolic Hypertension in Elderly Program (SHEP) Trial but the reduction in fatal events was not statistically significant.
Methods: Vital status was determined for 4,736 SHEP participants by matching to the National Death Index. We assessed the impact of stroke and TIA events during SHEP on long-term mortality using Cox regression adjusting for treatment and other factors.
Results: Patients with stroke during SHEP had significantly higher all cause mortality at 14.3 years mean follow-up, 65.6% (172/262) compared to 40.6% (1818/4352) among those free of stroke or TIA (adjusted RR 2.32, 95% CI 1.96 –2.74). They also were at higher risk for cardiovascular (CV) death (RR 2.42, 1.91–3.07) and stroke death (RR 3.85, 2.44 – 6.07). TIA was not significantly associated with increased total mortality (RR 1.09, 0.86 –1.39), CV death (1.38, 0.93–1.77), or stroke death (1.01, 0.78 –1.31). Treatment with chlorthalidone significantly reduced the risk of CV death (RR 0.86, 0.75– 0.98, p<0.0001) among those free from stroke or TIA, however total mortality was not significantly reduced. Among those with stroke there was a trend towards lower risk of total mortality (RR 0.77, 0.56 –1.06), CV death (0.75, 0.48 –1.15) and stroke death (0.61, 0.30 –1.22) with active treatment, but the association was not statistically significant due to wide confidence intervals.
Conclusion: The occurrence of stroke during the SHEP trial significantly increased the risk of long-term fatal outcomes. TIA was not associated with bad prognosis. Chlorthalidone-based treatment of hypertension significantly decreased CV mortality.