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The drug treatment of mild hypertension in the Multiple Risk Factor Intervention Trial. A review
Insights
The Multiple Risk Factor Intervention Trial found that intensive intervention did not significantly reduce coronary heart disease mortality in middle-aged men. However, certain subgroups experienced increased mortality, questioning hypertension treatment strategies.
Area of Science:
- Cardiovascular Disease Research
- Public Health Interventions
- Clinical Trials
Background:
- Coronary heart disease (CHD) poses a significant mortality risk in middle-aged men.
- Identifying effective interventions to lower CHD risk factors is crucial for public health.
- Previous research suggested benefits of multifactorial risk reduction.
Purpose of the Study:
- To evaluate the long-term effect of a comprehensive intervention program on CHD mortality.
- To assess the impact of lowering risk factors like cholesterol, smoking, and blood pressure.
- To investigate potential adverse effects or differential responses within subgroups.
Main Methods:
- A randomized controlled trial comparing 'special intervention' with 'usual care'.
- Special intervention included dietary changes, smoking cessation support, and pharmacological blood pressure management.
- Follow-up included assessment of CHD mortality over a 6-year period.
Main Results:
- Overall CHD mortality was 7.1% lower in the special intervention group, a non-significant difference.
- Hypertensive men with baseline ECG abnormalities in the intervention group had higher CHD mortality.
- An interaction between diuretic use and ECG abnormalities was observed in the intervention group.
Conclusions:
- The study raises questions about the efficacy of treating mild hypertension with certain drug classes.
- Metabolic alterations associated with antihypertensive medications may have clinical significance.
- Risk factor intervention benefits require careful consideration of patient subgroups and treatment specifics.
Abstract:
The Multiple Risk Factor Intervention Trial was a long term study on the benefit of lowering risk factors for coronary heart disease mortality in middle-aged men. Study participants were randomised to either 'special intervention' or 'usual care'. Intensive intervention for special intervention men involved cholesterol lowering dietary advice, behaviour modification for cigarette smoking and a stepped care pharmacological approach to lower blood pressure. Overall, at 6 years, there was a 7.1% lower coronary heart disease mortality in special intervention compared with usual care men, a statistically non-significant difference (Confidence Interval +25 to -15%). Subgroup analysis revealed that special intervention men who were hypertensive at baseline and who had resting ECG abnormalities experienced a higher coronary heart disease mortality than the comparable usual care group. Within group Cox regression analysis, with coronary heart disease mortality as the dependent variable, revealed an interaction between diuretic use and resting ECG abnormalities in special intervention men. Additional analyses of clinics revealed a higher special intervention/usual care mortality in those clinics that used mainly hydrochlorothiazide in special intervention hypertensives. Results of the Multiple Risk Factor Intervention Trial raise important questions concerning the treatment of mild hypertension, and the clinical significance of metabolic alterations of antihypertensive drugs.