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Hypertension, antihypertensive treatment, and sudden coronary death. The Framingham Study
W B Kannel1, L A Cupples, R B D'Agostino
1Section of Preventive Medicine and Epidemiology, Boston University Medical Center, MA 02118.
Insights
Antihypertensive treatment may increase sudden death risk in some hypertensive individuals, particularly men without prior heart disease. Further research is needed to understand this association and identify at-risk subgroups.
Area of Science:
- Cardiology
- Epidemiology
- Pharmacology
Background:
- Sudden death is a significant concern in hypertensive populations.
- The role of antihypertensive treatment in sudden cardiac death requires further elucidation.
Purpose of the Study:
- To investigate the association between antihypertensive treatment and sudden death risk in hypertensive individuals.
- To identify specific subgroups of hypertensive patients who may be at increased risk.
Main Methods:
- Analysis of 30-year follow-up data from the Framingham Study.
- Inclusion of 183 sudden deaths in men and 77 in women (ages 35-94).
- Multivariate analysis considering blood pressure, electrocardiographic abnormalities, and prior coronary heart disease.
Main Results:
- Hypertension tripled sudden death risk, especially without prior coronary heart disease.
- Men on antihypertensive treatment had over double the risk of sudden death.
- A higher proportion of men dying suddenly were on antihypertensive therapy compared to the general population.
Conclusions:
- Antihypertensive treatment may contribute to sudden death in a subset of hypertensive patients.
- The increased risk was observed across various subgroups, irrespective of prior cardiac conditions.
- Further investigation into the specific mechanisms and patient characteristics is warranted.
Abstract:
During 30 years of follow-up, there were 183 sudden deaths in men and 77 in women ages 35 to 94 years who participated in the Framingham Study. Risk of sudden death was increased threefold in hypertensive persons but only if there was no previously diagnosed coronary heart disease. Men receiving antihypertensive treatment had more than twice the risk of sudden death compared with those who were untreated, whether or not they had prior manifestations of coronary heart disease. More than twice as many men who died suddenly were receiving antihypertensive therapy compared with those in the population at risk of the same age. In those with overt coronary heart disease, 34% of those dying suddenly were on antihypertensive treatment compared with 18% of those of the same age in the general population. Multivariate analysis taking into account the level of blood pressure, electrocardiographic abnormalities, and previously diagnosed coronary heart disease and cardiac failure, all of which are predisposing factors for sudden death, indicated a persistent increased risk of sudden death in association with antihypertensive treatment. Tests of interaction indicate that the excess sudden death risk was not confined to those with electrocardiographic abnormalities. In women, it may be associated with diabetes. These data suggest that some feature of antihypertensive treatment as practiced in the general population may contribute to sudden death incidence in an ill-defined subgroup of hypertensive persons.