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Getting sheepish about stroke.

There is really nothing sheepish about stroke or about high blood pressure, which may cause stroke. Pardon our pun, but thanks to the National Heart, Lung and Blood Institute's Study of Hypertension in the Elderly Program (SHEP), we now know a lot more about treating ISH (isolated systolic hypertension).

ISH is the most common form of high blood pressure in the elderly. Although high blood pressure in younger persons usually affects both systolic pressure (the upper figure in a blood pressure reading) and diastolic pressure (the lower figure), only the systolic pressure is high with ISH-above 160 mm Hg (mercury). Diastolic pressure is usually below 90 mm Hg with ISH.

Current estimates indicate that 40 percent of Americans over age 50 have blood pressure high enough to warrant treatment, either through lifestyle change or with drugs. Among those over 60 with ISH, SHEP has shown that treatment cuts the risk of stroke by 36 percent.

For five years, SHEP followed a drug-treated group of 4,736 men and women over 60 with ISH. A low-dose diuretic (which increases the flow of urine) was the first course of treatment. When this did not control high blood pressure, researchers began using other drugs. Although some people, such as diabetics or angina patients, should not use diuretics, an editorial in the Journal of the American Medical Association concludes, "The SHEP trial has established conclusively that treatment of ISH in the elderly is beneficial."

Deaths from stroke have decreased markedly in the past 20 to 30 years, thanks to the fact that doctors routinely treat millions of Americans for high blood pressure. Most of these, however, have been persons with elevation of both systolic and diastolic blood pressures. Doctors have been more hesitant to use drugs to treat ISH in the elderly. Because many elderly persons have cerebral atherosclerosis (narrowing of the brain arteries), doctors thought that higher systolic blood pressure was necessary to pump blood into the brain. If so, lowering systolic pressure with drugs might cause a patient's normal diastolic pressure to fall to dangerously low levels. The result would be a reduced supply of oxygen to the brain.

Now that the SHEP study has shown the benefit of treating ISH, we can expect still fewer deaths from stroke in the elderly.
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Title Annotation:National Heart, Lung and Blood Institute's Study of Hypertension in the Elderly Program
Publication:Medical Update
Date:Nov 1, 1991
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