Morbidity, mortality, and antihypertensive treatment effects by extent of @entity731 in older adults with isolated systolic XXXX .

@entity1 @entity64 @entity455 @entity101 @entity1897 @entity731 @entity543 @entity165
BACKGROUND AND PURPOSE: The Systolic @entity101 in the Elderly Program (SHEP) demonstrated a significant reduction in @entity64 and coronary event rates among @entity1 randomly assigned to active blood pressure treatment. Selected @entity1 were evaluated for @entity1897 and followed up for cardiovascular events beyond the end of the SHEP trial. Antihypertensive treatment effects were evaluated based on the presence or absence of clinical or subclinical @entity731 . METHODS: As an ancillary study to SHEP, 190 @entity1 at the Pittsburgh center were evaluated for @entity1897 , defined as either an @entity543 (by duplex scan) or lower extremity @entity455 (identified by ankle blood pressure). @entity1 were subsequently followed up for cardiovascular events. RESULTS: Estimates of 4-year mortality rates were 4.8% for @entity1 with no @entity731 , 16.7% for those with subclinical @entity731 , and 23% among those with clinical evidence of @entity731 (P < .001). Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and 58.3% for the three groups, respectively (P < .001). Differences remained significant after adjustment for age, sex, treatment assignment, smoking, and high-density lipoprotein @entity165 . Individuals assigned to placebo at the beginning of SHEP had higher cardiovascular event rates than individuals assigned to active treatment (P = .011), with the most striking difference 3 or more years after the end of the SHEP trial. When this analysis was stratified by the presence or absence of detectable @entity731 , the absolute treatment effect was largest among those with evidence of disease. CONCLUSIONS: Individuals with systolic @entity101 and evidence of @entity1897 are at high risk for cardiovascular events. Targeting this group for antihypertensive therapy would result in the prevention of a large number of cardiovascular events.
