The Systolic Hypertension in the Elderly Program was randomized, placebo controlled trial which demonstrated a 36% reduction in 5-year stroke incidence among participants with isolated systolic hypertension randomized to active blood pressure treatment. As an ancillary study, carotid duplex scans were performed on 187 participants with systolic hypertension at the Pittsburgh center and 187 normotensive controls. This application proposes to follow both hypertensive and normotensive cohorts for an additional 5 years. Rates of carotid disease progression will be documented and the effect of antihypertensive therapy on progression rates will be evaluated. Preliminary data indicate that rates of carotid disease progression will be higher in hypertensive participants randomized to placebo than in those randomized to active treatment. Six to 10 year rates of stroke, myocardial infarction and death will be documented and event rates between those with and without carotid stenosis at baseline will be compared. Preliminary data indicate that event rates will be higher among those with carotid stenosis at baseline and that the beneficial effects of antihypertensive therapy will be most pronounced for this group. This may suggest that noninvasive measures of atherosclerosis could be used to identify high risk persons who would benefit from aggressive blood pressure therapy. Compliance with antihypertensive therapy will be documented and reasons for noncompliance established, possibly providing strategies to keep persons with systolic hypertension on appropriate therapy. Finally, the relationship between carotid disease and peroxidized LDL will be studied. Establishing a link between peroxidized LDL and risk of atherosclerosis may eventually suggest antioxidant therapy as a treatment strategy. To accomplish these goals, hypertensive and normotensive participants will undergo yearly clinic visits for collection of data on blood pressure, medications, hospitalizations and events. Events will be verified by medical record review. Repeat carotid scans will be done at 2 and 4 years following the initial scan. Measures of carotid disease will include Doppler measures of blood flow velocity, a summary measures of plaque and measures of intima-media thickness. Peroxidized LDL levels will be determined from frozen sera. In summary, this proposal will provide a wealth of information on the relationship between carotid disease, systolic hypertension and morbidity and mortality not available from any other source.
