Problem Isolated systolic hypertension, age > 60
Format Multicenter, randomized, double-blind, placebo-controlled trial
Treatment Chlorthalidone +- Atenolol
Control Placebo
Population 4736
Inclusion criteria Patients aged 60 years and above with Systolic BP between 160 and 219 mm Hg and diastolic BP less than 90 mm Hg

SHEP used primarily mass mailing and community screening techniques.

Exclusion criteria Persons were excluded on the basis of history and/or signs of specified major cardiovascular diseases. Other major diseases, eg. cancer, alcoholic liver disease,established renal dysfunction, withcompeting risk for the SHEP primary end point or the presence of medicalmanagement problems, were alsoexclusions
Follow-up 4.5 years average
Primary endpoint Nonfatal and fatal (total) stroke
Secondary endpoint(s) Cardiovascular and coronary morbidity and mortality, all-cause mortality, and quality of life measures
Details .
Brief summary: Chlorthalidone reduces stroke & CV events, may increase DM
PAPER: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP).
Date 26 Jun 1991
Journal JAMA. 1991 Jun 26;265(24):3255-64.
Information Low-dose chlorthalidone aged > 60:
Reduced incidence of total stroke by 36%
-5-year absolute benefit of 30 events per 1000 participants
Major cardiovascular events were reduced
-5-year absolute benefit of 55 events per 1000.
PAPER: Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes
Date 26 Jun 1991
Journal Am J Cardiol. 2005 Jan 1;95(1):29-35.
Information Increased follow-up to 14.3 years
-Increased development of diabetes but improved clinical outcomes
-Improved especially among diabetics
-Chlorthalidone-associated diabetes had no significant increase in CV events and had a better prognosis than had preexisting diabetics