Never before has antihypertensive trial’s confirmed results showcased as in here. A clear study proves that antihypertensive drugs diligently taken adds years to our lives.

Team@CMHF

Antihypertensive therapy with chlorthalidone-based stepped care therapy was associated with a lower rate of cardiovascular events than placebo, according to findings from the Systolic Hypertension in the Elderly Program (SHEP) trial, which took place from 1985 to 1990. However, the effect of stepped care therapy on mortality was not significant.

A “legacy effect” has been reported in some previous trials, in that the benefit of therapy on hypertension, hyperlipidemia, and diabetes appeared or persisted after the end of the trials when all patients were advised to receive active therapy. The goal of the present study by Kostis and colleagues was to measure the gain in life expectancy at the 22-year follow-up of SHEP participants randomly assigned to active antihypertensive treatment.

The first long-term data from the high-blood-pressure study SHEP show that each month of chlorthalidone-based therapy was associated with approximately one day of extension in life, free from cardiovascular death

“The main findings are that after 22 years of follow-up, when about 60% of the participants in SHEP were dead, we saw a prolonged life expectancy in those who took the active treatment for 4.5 years, and that is the first time this has been reported in studies of hypertension, because you have to wait a long time to find out differences in life expectancy,” lead author Dr John B Kostis  “In hypertension trials, by the time everybody dies, the investigators have died,” he added.

The study “is a strong message that may result in increased patient adherence to drug therapy and decrease the degree of therapeutic inertia by healthcare providers,” he and his colleagues say

Kostis cautions, however, that the gains relate primarily to CVD avoidance   and that other benefits of antihypertensive treatment, such as preventing strokes, could arguably be even more important than prolonging life.

If you start therapy early and live 20 more years, you will be productive and enjoy life.
“We all die, and if you don’t die from heart disease you have the opportunity of dying from something else. Immortality hasn’t been achieved yet in humans,” he noted.

But, he believes, “it’s better to live an extra year, then die from cancer.” And he points out that other benefits of antihypertensive therapy, such as preventing strokes, are perhaps even more important. “Preventing one stroke has many implications other than life expectancy; stroke is a terrible thing.”

Another key message from this trial is that the earlier therapy is started the better, says Kostis. “These patients happened to be elderly; they were 72, on average, when they were enrolled in this trial. But if you start treatment earlier you would have even better benefit. If you start therapy early and live 20 more years, you will be productive and enjoy life.”

Clinical Implications

• After 22 years of follow-up, patients in the active treatment group of the SHEP trial who were treated with a chlorthalidone-based stepped-care therapy for 4.5 years had significantly lower all-cause mortality rates.
• Patients in the intervention group of the SHEP trial who were treated with a chlorthalidone-based stepped-care therapy for 4.5 years also had significantly lower cardiovascular mortality rates after 22 years of follow-up. Receiving active treatment each month was associated with an additional day free from the risk for cardiovascular death.

Ref; http://www.medscape.org/viewarticle/756346?src=cmemp