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Prognostic and therapeutic considerations in pure hypertension vs hypertension and superimposed arteriosclerosis
Insights
Men with hypertension and arteriosclerosis face a high mortality rate (27%) despite treatment. Exaggerated cold pressor responses indicate poor prognosis, especially for coronary heart disease and stroke.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Vascular Biology
Background:
- Hypertension and arteriosclerosis significantly increase cardiovascular risk.
- Prognostic factors for patients with coexisting hypertension and arteriosclerosis require further elucidation.
- Early 20th-century treatment strategies for severe hypertension had limited impact on mortality.
Purpose of the Study:
- To evaluate the prognostic and therapeutic outcomes of patients with hypertension and superimposed arteriosclerosis.
- To identify predictors of mortality in this patient cohort.
- To assess the efficacy of antihypertensive agents in mitigating adverse cardiovascular events.
Main Methods:
- Retrospective analysis of 227 patients diagnosed between 1967-1969.
- Follow-up duration of 4-7 years.
- Assessment of cold pressor response (systolic, diastolic, pulse pressure) as a prognostic indicator.
Main Results:
- Overall mortality was 27% in males versus 3% in females.
- Elevated systolic and pulse pressure cold pressor response predicted arteriosclerosis.
- Exaggerated systolic and diastolic cold pressor response in males indicated poor prognosis for coronary heart disease and stroke.
- Hypertension treatment may prevent stroke but not coronary heart disease mortality.
Conclusions:
- Marked exaggeration in systolic and diastolic cold pressor response in males is a significant predictor of premature death from atherosclerotic vascular disease.
- Early detection and treatment of hypertension before arteriosclerosis development are crucial, particularly in males.
- Sudden death was common, with many patients not reaching hospital care.
Abstract:
In summary, a prognostic and therapeutic evaluation of 227 patients first seen from 1967 to the end of 1969 with a follow-up of 4-7 years was made. The results are indeed depressing. In spite of close follow-up and systematic treatment with modern antihypertensive agents, the mortality of patients having hypertension with superimposed arteriosclerosis was 27% (15 to 56) for males as contrasted to 3% (2 of 75) for females. Since the last casual blood pressure in both living and deceased patients of the mixed group were similar, the level of blood pressure following treatment could not be incriminated for the deceased patients. An exaggerated systolic and pulse pressure cold pressor response emerged as an important indicator of presence of arteriosclerosis alone. When hypertension and arteriosclerosis coexisted there was also exaggeration in diastolic cold pressor response. A further exaggeration in systolic and diastolic cold pressor response was seen in the decreased as compared to living male patients, a finding which appears to have grave prognostic significance for coronary heart disease and stroke. Thus a marked exaggeration in both systolic and diastolic cold pressor response in males might prove to be the single most important predictor of premature death from atherosclerotic vascular disease. A further analysis of the deceased male patients having hypertension and superimposed arteriosclerosis, indicates that treatment of hypertension may prevent oeath from stroke but not form coronary heart disease. Two-thirds of the deaths occur suddenly and only one-third of the deceased patients reached the hospital befor dying. In view of these distressing findings a plea for early detection and treatment of hypertension, prior to the development of superimposed arteriosclerotic changes, particularly in males, is made.