Chlorthalidone: Drug of Choice for Stroke Prevention & Life Expectancy?

Yesterday, I pointed out a study linking silent strokes to worse cognitive function.  The big question, then, is how to prevent strokes, silent or not.  Well, 2 decades ago, the Systolic Hypertension in the Elderly Program (SHEP) demonstrated that compared to placebo, use of chlorthalidone, a thiazide diuretic similar to the more commonly prescribed hydrochlorothiazide or HCTZ, for 4+yrs lead to a 36% reduction in stroke in 4736 elderly patients (>60yo) with isolated systolic hypertension (>160mm Hg).  This amounted to an absolute reduction of 30 events per 1,000 patients treated over 5yrs.  Cardiovascular events were also reduced in an absolute fashion by 55 per 1,000 over this same period of time.

But what about the rest of the story?  Well, after the results were announced, all the participants were encouraged to either switch to or continue with antihypertensive therapy, eg chlorthalidone.  In a bit of detective work, authors noted last month that those patients initially randomized to chlorthalidone almost 22yrs earlier liver longer by 105 days than those initially randomized to placebo.  In other words, for every month of additional treatment, they lived a day longer, regardless of cause of death, in essence, a measure of all-cause mortality.  More impressive were the results obtained by those who achieved goal systolic blood pressure <140mm Hg: they lived 333 days longer.

What's this study mean for you & me?  It's never too early to aggressively manage one's elevated blood pressure to prevent (silent) strokes and extend one's life.  So what are you waiting for?  Go measure your blood pressure and if you need it, start taking your medication as directed.

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