Abstract 13664: The Systolic Hypertension in the Elderly Program: Competing Cardiovascular and Non-Cardiovascular Risk and Increased Longevity

Abstract

Background: A decrease in cardiovascular (CV) mortality of participants in the Systolic Hypertension in the Elderly Program (SHEP) has been reported. Here we examine the effect of chlorthalidone-based therapy on CV versus non-CV death and the probability of becoming a centenarian, in comparison to an age- and gender-matched cohort. [[Unable to Display Character:
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Methods: SHEP was a double-blind placebo-controlled clinical trial with a randomized period of 4.5 years in otherwise healthy older patients with isolated systolic hypertension. Using the National Death Index, we examined the 22-year mortality outcomes in the active treatment and placebo groups of SHEP as well as in comparison to persons matched for gender, race, and age at randomization. Differences in life expectancy were computed from the area between survival curves.

Results: At the 22-year follow up, the gain in life expectancy free from CV death in the active treatment group was 145 days (95% CI 23 to 260, p=0.012). The gain in overall life expectancy was smaller (105 days, CI -39 to 242, p=0.073), because of a 40-day (-87, 161) decrease in life expectancy from competing non-CV death. The ratio of CV deaths to all deaths was lower in the active treatment group (45% vs. 50%, p=0.0003). Compared to the age- and gender-matched cohort, SHEP participants had higher all-cause life expectancy (Wilcoxon p<0.00001) and higher chance of reaching the ages of 80 (81.3% vs. 57.6), 85 (58.1 vs. 37.4), 90 (30.5 vs. 22.0), 95 (11.9 vs. 8.8), and 100 (3.7 vs. 2.8).[[Unable to Display Character:
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Conclusions: At the 22-year follow-up of SHEP, 4.5 years of active therapy was associated with a significant increase in life expectancy free from CV death but with a small decrease in life expectancy free from the competing risk of non-CV death. SHEP participants had higher life expectancy and chance of living to very old age than actuarial controls.