Long-term predictors of increased mortality risk in screened men with new hypertension; the Malmo preventive project

Regular blood pressure control has been advocated for early detection and treatment of patients with hypertension. We aimed to study whether long-term survival rate is related to socioeconomic circumstances and biological factors among middle-aged men with screened new hypertension.

Of the 22,444 men who attended a general health examination in Malmo, Sweden during 1974--1984, in total, 2033 had a systolic or diastolic blood pressure of at least 160 or 100 mmHg and were without treatment for hypertension. Mean age was 45.8 (SD: 5.3) years. All-cause mortality was studied in relation to smoking, diabetes, hyperlipidaemia, being overweight, marital status, problematic alcohol drinking, and occupation over a mean follow-up of 18.6 (3.6) years.

Screened hypertension (> or = 160/ > or = 100 mmHg) was significantly more common among men with low occupational level and among single men. Higher risk factor levels were associated with an adverse social background. Of the men with screened hypertension, 479 (24%) died during the follow-up, half of them from cardiovascular diseases. Compared with married men with normal blood pressure, married men with screened hypertension had a relative mortality risk of 1.5 (95% confidence interval = 1.3-1.7), whereas the relative risk for corresponding single men was 3.0 (2.6-3.4) adjusted for confounders. Among men with screened hypertension, marital status, systolic blood pressure at baseline, smoking, diabetes, hyperlipidaemia, and low occupation level (manual) remained significantly associated with total mortality in the multivariate analysis.

Marital status contributes substantially to the survival prognosis for men with screened new hypertension. Systolic blood pressure at baseline and other known risk factors for atherosclerosis were also associated with increased mortality in this group.