Hulley S B, Furberg C D, Gurland B, McDonald R, Perry H M, Schnaper H W, Schoenberger J A, Smith W M, Vogt T M
Am J Cardiol. 1985 Dec 1;56(15):913-20. doi: 10.1016/0002-9149(85)90404-7.
The Systolic Hypertension in the Elderly Program (SHEP) is a randomized, blinded test of the efficacy of antihypertensive drug treatment. In a large feasibility trial, 551 men and women who had isolated systolic hypertension and were at least 60 years old received chlorthalidone (25 to 50 mg/day) or matching placebo as the step I drug. After 1 year, 83% of the chlorthalidone group and 80% of the placebo group were still taking SHEP medications. Of those still taking chlorthalidone, 88% had reached goal blood pressure (BP) without requiring a step II drug, and most had responded to the lower dose (25 mg/day). The BP response was similar in all age, sex and race subgroups, with an overall mean difference between randomized groups of 17 mm Hg for systolic BP (p less than 0.001) and 6 mm Hg for diastolic BP (p less than 0.001). The only common adverse effects were asymptomatic changes in the serum levels of potassium (0.5 mEq/liter lower in the chlorthalidone group, p less than 0.001), uric acid (0.9 mg/dl higher, p less than 0.001) and creatinine (0.08 mg/dl higher, p = 0.02). This study indicates that chlorthalidone is effective for lowering BP in elderly patients with systolic hypertension and sets the stage for a larger trial of the effects of such treatment on the incidence of cardiovascular disease.
老年收缩期高血压项目（SHEP）是一项关于抗高血压药物治疗疗效的随机、双盲试验。在一项大型可行性试验中，551名年龄至少60岁的单纯收缩期高血压男性和女性接受了氯噻酮（25至50毫克/天）或匹配的安慰剂作为I级药物。1年后，氯噻酮组83%的患者和安慰剂组80%的患者仍在服用SHEP药物。在仍服用氯噻酮的患者中，88%在无需II级药物的情况下达到了目标血压（BP），且大多数对较低剂量（25毫克/天）有反应。在所有年龄、性别和种族亚组中，血压反应相似，随机分组之间收缩压的总体平均差异为17毫米汞柱（p<0.001），舒张压为6毫米汞柱（p<0.001）。唯一常见的不良反应是血清钾水平的无症状变化（氯噻酮组低0.5毫当量/升，p<0.001）、尿酸（高0.9毫克/分升，p<0.001）和肌酐（高0.08毫克/分升，p = 0.着02）。这项研究表明，氯噻酮对降低老年收缩期高血压患者的血压有效，并为进一步试验此类治疗对心血管疾病发病率的影响奠定了基础。
