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Elizabeth O. Ofili, MD, MPH; Jerome D. Cohen, MD; Jeanette A. St. Vrain, RDMS; Anthony Pearson, MD; Timothy J. Martin, MD; Norbert D. Uy, MD; Ramon Castello, MD; Arthur J. Labovitz, MD

JAMA. 1998;279:778-780.

Context.— Left ventricular (LV) hypertrophy is a common problem among elderly patients with isolated systolic hypertension (ISH), but the effect of treatment of ISH on LV mass is not known.

Objective.— To assess the ability of antihypertensive drug treatment to reduce LV mass in ISH.

Design.— Echocardiographic Substudy of the Systolic Hypertension in the Elderly Program (SHEP).

Patients.— A total of 104 participants at the St Louis SHEP site who had interpretable baseline echocardiograms, 94 of whom had 3-year follow-up echocardiograms.

Intervention.— The SHEP participants were randomized to placebo or active treatment with chlorthalidone (12.5-25 mg/d), with atenolol (25-50 mg/d) added if necessary to maintain goal blood pressure.

Main Outcome Measure.— Change in LV mass assessed by echocardiography.

Results.— Minimum follow-up was 3 years. In the active treatment group, 91% and 80% of subjects were receiving treatment with chlorthalidone alone by the end of years 1 and 3, respectively. The LV mass index was 93 g/m² in the active treatment group and 100 g/m² in the placebo group (P<.001). The LV mass index declined by 13% (95% confidence interval, - 3% to - 23%) in the active treatment group compared with a 6% increase (95% confidence interval, - 3% to + 16%) in the placebo group over 3 years (P=.01).

Conclusion.— Treatment of ISH with a diuretic-based regimen reduces LV mass.

From the Section of Cardiology, Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Ga (Dr Ofili); Division of Cardiology, Department of Internal Medicine, St Louis University Medical Center, St Louis, Mo (Drs Cohen, Martin, Uy, Castello, and Labovitz and Ms St. Vrain); and Division of Cardiology, Ohio State University College of Medicine, Columbus (Dr Pearson).

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