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Stroke and coronary heart disease in treated hypertension -- a prospective cohort study over three decades
T Almgren1, B Persson, L Wilhelmsen
1Hypertension Clinic, Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.
Insights
Treated hypertensive men experienced significantly higher rates of stroke, myocardial infarction, and cardiovascular mortality compared to nonhypertensive men, despite blood pressure reduction. This increased risk escalated over time, highlighting persistent cardiovascular risks.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Epidemiology
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Understanding long-term outcomes in treated hypertensive individuals is crucial for public health.
- Population-based studies provide valuable insights into disease progression and risk factors.
Purpose of the Study:
- To compare cardiovascular mortality and morbidity between middle-aged hypertensive and nonhypertensive men.
- To investigate stroke risk factors in hypertensive men over a 25-28 year follow-up period.
Main Methods:
- A prospective, population-based observational study comparing 754 hypertensive men with 6740 nonhypertensive men (aged 47-55).
- Hypertensive men received stepped care treatment for hypertension.
- Data on mortality and morbidity (stroke, coronary heart disease) were collected over 25-28 years.
Main Results:
- Treated hypertensive men experienced a doubled incidence of stroke and coronary heart disease mortality, and a 50% increase in myocardial infarctions.
- All-cause mortality was one-third higher in the treated hypertensive group.
- Stroke incidence was linked to smoking and diabetes at baseline, and solely to smoking in time-dependent analysis.
- No correlation was found between achieved blood pressure levels or blood pressure changes and the risk of stroke or myocardial infarction.
Conclusions:
- Treated middle-aged hypertensive men face a substantially elevated risk of stroke, myocardial infarction, and cardiovascular mortality, even with significant blood pressure reduction.
- The increased risk of cardiovascular complications in treated hypertensive men escalated over the study's latter course.
- These findings underscore the complexity of hypertension management and the need for comprehensive cardiovascular risk factor control.
Objective:
To compare cardiovascular mortality and morbidity in middle-aged hypertensive men with initially nonhypertensive men derived from the same random population sample, and to study stroke morbidity in these men in relation to cardiovascular risk factors during 25-28 years of follow-up.
Design:
Prospective, population-based observational study in men where the main intervention effort was directed towards treatment of hypertension in a special outpatient clinic.
Subjects And Methods:
A total of 754 hypertensive men aged 47-55 years at screening were compared with 6740 men with normal blood pressure. The hypertensive men got stepped care treatment with either beta-blockers, thiazide diuretics, or combination treatment including vasodilating agents during the whole observational period. Data on cause-specific mortality and morbidity, and all cause mortality were obtained from patient files and the national registers on mortality and hospital admissions respectively.
Main Outcome Measures:
Baseline and change of cardiovascular risk factors during the first 15 years of follow-up and all cause mortality, and mortality and morbidity from stroke and coronary heart disease during 25-28 years.
Results:
Treated hypertensive men had their blood pressure reduced with 21/15 mmHg during the first 5 years of the study and mean blood pressure levels were then rather constant. A minor reduction of serum cholesterol was also observed and a significant reduction in the prevalence of smoking. Treated hypertensive men suffered a substantial increased incidence of cardiovascular complications that escalated during the latter course of the study. Their total incidence of stroke was doubled; they had 50% more myocardial infarctions (MIs); mortality from coronary heart disease was doubled and all cause mortality was increased by a third, compared with nonhypertensive. In multiple regression analysis the incidence of stroke was significantly related to smoking and diabetes at entry and in time-dependent Cox's regression analysis it was significantly related only to smoking. There was no relationship observed between achieved systolic or diastolic blood pressure and the risk of stroke or MI nor was there any relationship between the change in blood pressure and such cardiovascular complications.
Conclusion:
In spite of a substantial reduction of their blood pressure, treated hypertensive middle-aged men had a highly increased risk of stroke, MI and mortality from coronary heart disease compared with nonhypertensive men of similar age. The increased risk of cardiovascular complications escalated during the latter course of the study.
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