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Changes in hypertension treatment and in congestive heart failure mortality in the United States
1Clinical Trials Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland 20892.
Insights
Antihypertensive drug use has increased, particularly in older adults. Despite this, congestive heart failure mortality is decreasing in younger populations but rising in older ones, suggesting treatment may delay, not prevent, heart failure.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Increased use of antihypertensive agents noted, especially in older age groups (65-74 years).
- Hypertension is a significant risk factor for congestive heart failure (CHF).
- Expected outcome of increased antihypertensive use is a reduction in CHF incidence.
Purpose of the Study:
- To explore divergent trends in CHF mortality across different age groups.
- To investigate the apparent inconsistency between rising antihypertensive drug use and changing CHF mortality rates.
- To examine the impact of antihypertensive treatments on the timing of CHF development.
Main Methods:
- Analysis of national death statistics.
- Comparison of CHF mortality trends in middle-aged (45-54 years) versus older (65-74 years) adults.
- Exploration of potential reasons for observed mortality trends.
Main Results:
- Decreases in CHF mortality observed in younger age groups.
- Increases in CHF mortality observed in older age groups.
- Divergent mortality trends noted despite increased antihypertensive agent use.
Conclusions:
- Antihypertensive treatment may not prevent CHF but rather postpones its onset by decades.
- Further research is needed to understand the long-term effects of antihypertensive therapy on CHF progression.
- The findings suggest a need to re-evaluate treatment strategies for hypertension in relation to CHF prevention in aging populations.
Abstract:
The use of antihypertensive agents has increased in recent years and has been more marked among individuals in older age groups (65-74 years) than in middle-aged groups (45-54 years). Because hypertension is a strong risk factor for the development of congestive heart failure, more common use of antihypertensive agents would be expected to reduce the incidence of congestive heart failure. Examination of the national death statistics reveals decreases in congestive heart failure mortality at younger ages with mortality increases at older ages. The reasons for these divergent trends in congestive heart failure mortality in different ages and the apparent inconsistency with respect to the changes in the use of antihypertensive drugs are explored. We speculate that antihypertensive treatment does not completely prevent congestive heart failure but merely postpones its development by several decades.