Ménard J, Chatellier G
Centre de Médecine préventive cardiovasculaire, Hôpital Broussais, Paris.
Presse Med. 1992 Nov 7;21(37):1762-7.
SHEP (Systolic Hypertension in the Elderly Program) is a multicenter controlled therapeutic trial which included 4,736 subjects aged 60 years and over, who had isolated systolic hypertension at three consecutive visits at the outpatient clinic. The treatment, based on low doses of diuretic (chlorthalidone 12.5-25 mg daily) combined, when necessary, with a cardioselective beta-blocker (atenolol 25 to 50 mg daily), significantly reduced the incidence of cerebrovascular and coronary events; the relative risk reduction for total mortality was not statistically significant. The beneficial cardiovascular effects were observed in both sexes, and in the 80+ age group. These results show that this particular therapy applied to this form of hypertension decreases the risk of both coronary and cerebral events, as was already suggested by the meta-analysis of the controlled therapeutic trials performed with diuretics, beta-blockers and other older antihypertensive drugs in patients with permanent diastolic hypertension. They also show the limitations of this therapeutic strategy, which controlled only 50 percent of the patients who were, however, highly selected, especially concerning the absence of associated morbid conditions and treatments. The need for, and feasibility of, new controlled therapeutic trials comparing the mortality and morbidity associated with various new antihypertensive therapies must now be discussed.
老年收缩期高血压计划（SHEP）是一项多中心对照治疗试验，纳入了4736名60岁及以上的受试者，这些受试者在门诊连续三次就诊时均患有单纯收缩期高血压。治疗方案基于低剂量利尿剂（每日氯噻酮12.5 - 25毫克），必要时联合使用心脏选择性β受体阻滞剂（每日阿替洛尔25至50毫克），该方案显著降低了脑血管和冠状动脉事件的发生率；总死亡率的相对风险降低无统计学意义。在男性和女性以及80岁以上年龄组中均观察到了有益的心血管效应。这些结果表明，应用于这种高血压形式的这种特定疗法可降低冠状动脉和脑血管事件的风险，利尿剂、β受体阻滞剂和其他较老的抗高血压药物在持续性舒张压高血压患者中进行的对照治疗试验的荟萃分析已表明了这一点。它们还显示了这种治疗策略的局限性，该策略仅控制了50%的患者，然而这些患者是经过高度挑选的，尤其是在没有相关疾病和治疗方面。现在必须讨论进行新的对照治疗试验的必要性和可行性，以比较各种新的抗高血压疗法相关的死亡率和发病率。
