We sought to determine risk factors for stroke and stroke type in persons with isolated systolic hypertension (ISH).We performed proportional hazards analyses of data from the Systolic Hypertension in the Elderly Program, a double-blind, randomized, placebo-controlled trial of 4736 persons aged > or =60 years with ISH (systolic blood pressure, 160 to 219 mm Hg; diastolic blood pressure, <90 mm Hg). One treatment group received chlorthalidone (12.5 to 25 mg/d) with step-up to atenolol (25.0 to 50.0 mg/d) or reserpine (0.05 to 0.10 mg/d), if needed. The other treatment group received matching placebo. The main outcome measures were stroke, stroke or transient ischemic attack [TIA], and stroke types: ischemic (including lacunar, atherosclerotic, and embolic) and hemorrhagic.During an average follow-up of 4.5 years, 384 strokes or TIAs and 262 strokes (including 217 ischemic, 66 lacunar, 26 atherosclerotic, and 25 embolic strokes) were documented. In multivariate analyses, placebo treatment, older age, smoking, history of diabetes, higher systolic blood pressure, lower HDL cholesterol, and ECG abnormality were significantly associated (P<0.05) with increased incidence of stroke or TIA, stroke, or ischemic stroke. Greater lacunar stroke risk was significantly related to placebo treatment, older age, history of diabetes (relative risk [RR] = 3.03; 95% confidence interval [CI], 1.70 to 5.40), and smoking (RR = 3.04; 95% CI, 1.73 to 5.37). Greater atherosclerotic and embolic stroke risk were significantly related to presence of carotid bruit (RR = 5.75; 95% CI, 2.50 to 13.24) and older age (RR = 1.65 per 5 years; 95% CI, 1.25 to 2.18), respectively.In older persons with ISH, history of diabetes and smoking are important risk factors for lacunar stroke, whereas carotid bruit and age are important risk factors for atherosclerotic and embolic stroke, respectively.

Background and Purpose —We sought to determine risk factors for stroke and stroke type in persons with isolated systolic hypertension (ISH). Methods —We performed proportional hazards analyses of data from the Systolic Hypertension in the Elderly Program, a double-blind, randomized, placebo-controlled trial of 4736 persons aged ≥60 years with ISH (systolic blood pressure, 160 to 219 mm Hg; diastolic blood pressure, <90 mm Hg). One treatment group received chlorthalidone (12.5 to 25 mg/d) with step-up to atenolol (25.0 to 50.0 mg/d) or reserpine (0.05 to 0.10 mg/d), if needed. The other treatment group received matching placebo. The main outcome measures were stroke, stroke or transient ischemic attack [TIA], and stroke types: ischemic (including lacunar, atherosclerotic, and embolic) and hemorrhagic. Results —During an average follow-up of 4.5 years, 384 strokes or TIAs and 262 strokes (including 217 ischemic, 66 lacunar, 26 atherosclerotic, and 25 embolic strokes) were documented. In multivariate analyses, placebo treatment, older age, smoking, history of diabetes, higher systolic blood pressure, lower HDL cholesterol, and ECG abnormality were significantly associated ( P <0.05) with increased incidence of stroke or TIA, stroke, or ischemic stroke. Greater lacunar stroke risk was significantly related to placebo treatment, older age, history of diabetes (relative risk [RR]=3.03; 95% confidence interval [CI], 1.70 to 5.40), and smoking (RR=3.04; 95% CI, 1.73 to 5.37). Greater atherosclerotic and embolic stroke risk were significantly related to presence of carotid bruit (RR=5.75; 95% CI, 2.50 to 13.24) and older age (RR=1.65 per 5 years; 95% CI, 1.25 to 2.18), respectively. Conclusions —In older persons with ISH, history of diabetes and smoking are important risk factors for lacunar stroke, whereas carotid bruit and age are important risk factors for atherosclerotic and embolic stroke, respectively.

HomeHypertensionVol. 17, No. 3_supplementSystolic Hypertension in the Elderly Program (SHEP). Part 6: Baseline physical examination findings. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBSystolic Hypertension in the Elderly Program (SHEP). Part 6: Baseline physical examination findings. H R Black, D Unger, A Burlando, J C Wright, S L Pressel, R Allen, R H McDonald and H Surath H R BlackH R Black , D UngerD Unger , A BurlandoA Burlando , J C WrightJ C Wright , S L PresselS L Pressel , R AllenR Allen , R H McDonaldR H McDonald and H SurathH Surath Originally published1 Mar 1991https://doi.org/10.1161/01.HYP.17.3_Suppl.II77Hypertension. 1991;17 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Aronow W, Fleg J, Pepine C, Artinian N, Bakris G, Brown A, Ferdinand K, Ann Forciea M, Frishman W, Jaigobin C, Kostis J, Mancia G, Oparil S, Ortiz E, Reisin E, Rich M, Schocken D, Weber M, Wesley D, Harrington R, Bates E, Bhatt D, Bridges C, Eisenberg M, Ferrari V, Fisher J, Gardner T, Gentile F, Gilson M, Hlatky M, Jacobs A, Kaul S, Moliterno D, Mukherjee D, Rosenson R, Stein J, Weitz H and Wesley D (2011) ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly, Journal of the American Society of Hypertension, 10.1016/j.jash.2011.06.001, 5:4, (259-352), Online publication date: 1-Jul-2011. Aronow W, Fleg J, Pepine C, Artinian N, Bakris G, Brown A, Ferdinand K, Forciea M, Frishman W, Jaigobin C, Kostis J, Mancia G, Oparil S, Ortiz E, Reisin E, Rich M, Schocken D, Weber M and Wesley D (2011) ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly, Circulation, 123:21, (2434-2506), Online publication date: 31-May-2011. Aronow W, Fleg J, Pepine C, Artinian N, Bakris G, Brown A, Ferdinand K, Ann Forciea M, Frishman W, Jaigobin C, Kostis J, Mancia G, Oparil S, Ortiz E, Reisin E, Rich M, Schocken D, Weber M and Wesley D (2011) ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly, Journal of the American College of Cardiology, 10.1016/j.jacc.2011.01.008, 57:20, (2037-2114), Online publication date: 1-May-2011. Cohen D and Townsend R (2007) The Ankle-Brachial Index and Peripheral Pulses in Hypertensive Patients, The Journal of Clinical Hypertension, 10.1111/j.1524-6175.2007.06271.x, 9:2, (143-144), Online publication date: 1-Feb-2007. Franklin S, Sutton-Tyrrell K, Belle S, Weber M and Kuller L (1997) The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults, Journal of Hypertension, 10.1097/00004872-199715100-00012, 15:10, (1143-1150), Online publication date: 1-Oct-1997. Sutton-Tyrrell K, Bostom A, Selhub J and Zeigler-Johnson C (1997) High Homocysteine Levels Are Independently Related to Isolated Systolic Hypertension in Older Adults, Circulation, 96:6, (1745-1749), Online publication date: 16-Sep-1997. Frost P, Davis B, Burlando A, Curb J, Guthrie G, Isaacsohn J, Wassertheil-Smoller S, Wilson A and Stamler J (1996) Serum Lipids and Incidence of Coronary Heart Disease, Circulation, 10.1161/01.CIR.94.10.2381, 94:10, (2381-2388), Online publication date: 15-Nov-1996. Frost P, Davis B, Burlando A, David Curb J, Guthrie G, Isaacsohn J, Wassertheil-Smoller S, Wilson A and Stamler J (1996) Coronary Heart Disease Risk Factors in Men and Women Aged 60 Years and Older , Circulation, 94:1, (26-34), Online publication date: 1-Jul-1996.Sutton-Tyrrell K, Alcorn H, Herzog H, Kelsey S and Kuller L (1995) Morbidity, Mortality, and Antihypertensive Treatment Effects by Extent of Atherosclerosis in Older Adults With Isolated Systolic Hypertension, Stroke, 26:8, (1319-1324), Online publication date: 1-Aug-1995. Sutton-Tyrrell K, Wolfson S and Kuller L (1994) Blood pressure treatment slows the progression of carotid stenosis in patients with isolated systolic hypertension., Stroke, 10.1161/01.STR.25.1.44, 25:1, (44-50), Online publication date: 1-Jan-1994. Sutton-Tyrrell K, Alcorn H, Wolfson S, Kelsey S and Kuller L (1993) Predictors of carotid stenosis in older adults with and without isolated systolic hypertension., Stroke, 24:3, (355-361), Online publication date: 1-Mar-1993. (1993) Implications of the systolic hypertension in the elderly program. The Systolic Hypertension in the Elderly Program Cooperative Research Group., Hypertension, 10.1161/01.HYP.21.3.335, 21:3, (335-343), Online publication date: 1-Mar-1993. Moyé L, Davis B, Hawkins C and Probstfield J (2009) Conclusions and Implications of the Systolic Hypertension in the Elderly Program, Clinical and Experimental Hypertension, 10.3109/10641969309037081, 15:6, (911-924), Online publication date: 1-Jan-1993. March 1991Vol 17, Issue 3_supplement Advertisement Article InformationMetrics Copyright © 1991 by American Heart Associationhttps://doi.org/10.1161/01.HYP.17.3_Suppl.II77PMID: 1999377 Originally publishedMarch 1, 1991 PDF download Advertisement

Objective : The objective of this study was to examine the prevalence and correlates of postural hypotension (defined as a drop in systolic blood pressure of ≥20 mm Hg) in a cohort of elderly persons with isolated systolic hypertension (ISH). Design : Baseline cross‐sectional analysis of the 4,736 persons randomized in the Systolic Hypertension in the Elderly Program (SHEP). Setting : A randomized multi‐center double‐blind outpatient clinical trial of the impact of treating ISH. Participants: Men and women age ≥60 years with the systolic blood pressure (SBP) ≥ 160 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg. Measures : Medical histories were obtained using interviewer‐administered, standardized clinical history forms. At entry into the study, seated and standing BP was measured by certified BP technicians using a random zero sphygmomanometer. Postural hypotension (PH) was assessed at 1 and 3 minutes after the participant arose from a seated position. Main results : PH was found in 10.4% of participants at 1 minute and in 12.0% of participants at 3 minutes. 5.3% of participants demonstrated PH at both time intervals while 17.3% demonstrated PH at either or both of the time intervals. Factors significantly ( P < 0.05) associated with the presence of PH were higher mean SBP and a lower mean body mass index. Conclusions : Somewhat different persons were defined as having PH based upon the 1 minute and 3 minute standing measures of BP, and prevalence estimates of PH can vary depending on whether one or more intervals of measurement are used. Cross‐sectional data analysis indicated that PH, in healthy community‐dwelling older persons with ISH, may not be associated with a history of disorders or problems usually thought to be related to PH. However, prospective data are needed to determine the prognostic significance of PH, and whether one or multiple measurements carry more significance.