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Further results of the MRC treatment trial for mild hypertension
W E Miall1, G Greenberg, P Brennan
1MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, UK.
Insights
Mildly hypertensive adults treated with bendrofluazide or propranolol showed reduced stroke risk. However, neither drug reduced coronary events or all-cause mortality, indicating nuanced treatment effects for hypertension management.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Mild hypertension affects a significant adult population.
- Effective long-term management strategies are crucial for preventing cardiovascular events.
- Previous trials have established benefits of treating hypertension, but subgroup analyses are essential for personalized medicine.
Purpose of the Study:
- To evaluate the long-term effects of bendrofluazide and propranolol compared to placebo in mildly hypertensive adults.
- To investigate subgroup differences in treatment efficacy for stroke, coronary events, and ECG changes.
- To explore the interaction between cigarette smoking and drug efficacy in hypertension management.
Main Methods:
- A randomized, placebo-controlled trial involving 17,354 mildly hypertensive adults.
- Participants had diastolic blood pressure between 90-109 mm Hg.
- Treatments included bendrofluazide, propranolol, or placebo over 5 1/2 years.
Main Results:
- Treatment with bendrofluazide or propranolol demonstrated a significant benefit in reducing stroke incidence.
- No overall reduction in the incidence of coronary events or all-cause mortality was observed with either drug.
- Further analyses revealed subgroup-specific differences in treatment effects on stroke, coronary events, and ECG changes.
Conclusions:
- Bendrofluazide and propranolol offer stroke protection in mild hypertension but do not universally reduce coronary events or mortality.
- Subgroup analyses suggest potential variations in drug efficacy based on patient characteristics.
- The interaction between smoking status and drug efficacy warrants further investigation to guide therapeutic choices in mild hypertension management.
Abstract:
17,354 mildly hypertensive adults with diastolic (v) pressures of 90-109 mm Hg took part in a 5 1/2 year trial in which each was randomized to treatment with either bendrofluazide, propranolol, or placebo. The main results of the trial have been published; they showed stroke benefit but no overall reduction in the incidence of coronary events and no effect on all-cause mortality. Further analyses of the data have shown interesting differences between subgroups of the population, with regard to the effects of the two types of treatment on stroke, on coronary events and on ECG changes. These results, and the effects of interaction between cigarette smoking and the efficacy of these drugs, if confirmed in other studies, should influence the choice of drug therapy for mild hypertension.