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The efficacy of multiple risk factor intervention in treated hypertensive men during long-term follow up. Risk Factor
S Agewall1, J Wikstrand, O Samuelsson
1Department of Medicine, Sahlgrenska University Hospital, Göteborg University, Sweden.
Insights
This study found a multifactorial intervention effectively reduced hypercholesterolaemia and smoking rates in hypertensive patients. The intervention group also experienced a significant decrease in stroke incidence, highlighting its cardiovascular benefits.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Clinical Trial Research
Background:
- Hypertension management requires addressing multiple cardiovascular risk factors.
- Hypercholesterolaemia, smoking, and diabetes mellitus significantly increase cardiovascular risk in hypertensive patients.
- Long-term intervention efficacy in this patient group warrants investigation.
Purpose of the Study:
- To assess the feasibility and efficacy of a multifactorial intervention for hypercholesterolaemia, smoking, and diabetes mellitus in treated hypertensive patients.
- To evaluate cardiovascular complication incidence after over 3 years of follow-up.
- To compare a comprehensive risk factor modification program against usual care.
Main Methods:
- An open, randomized, parallel-group study involving 508 male patients (aged 50-72) with treated hypertension and at least one additional risk factor.
- Intervention included individualized advice and group sessions on nutrition and behavior, with drug therapy to meet specific lipid, smoking, and glycemic targets.
- Usual care served as the control group, with a shared goal of diastolic blood pressure below 90 mmHg.
Main Results:
- The intervention group showed a 5.0% greater reduction in serum cholesterol and a 17.6% higher smoking cessation rate compared to the usual care group.
- Diastolic blood pressure and HbA1c levels did not significantly differ between groups.
- Stroke incidence was significantly lower in the intervention group (2.0%) versus the usual care group (6.7%).
Conclusions:
- The multifactorial intervention program demonstrated success in improving hypercholesterolaemia and smoking habits.
- An unexpected, significant reduction in stroke incidence was observed in the intervention group.
- These findings support comprehensive risk factor management for reducing cardiovascular events in hypertensive patients.
Objective:
To examine the feasibility and efficacy of a multifactorial intervention programme directed towards hypercholesterolaemia, smoking, and diabetes mellitus in treated hypertensive patients after more than 3 years' follow-up and to describe the incidence of cardiovascular complications.
Design:
Open, randomized, parallel-group study with allocation either to a comprehensive multiple risk factor modification programme or to usual care.
Setting:
Outpatient clinic in a city hospital.
Patients:
A total of 508 male patients with treated hypertension, aged 50-72 years, with at least one of the following: serum cholesterol > or = 6.5 mmol L-1, smoking or diabetes mellitus.
Intervention:
Individually given advice and group meetings based on nutritional advice and behavioral treatment principles. Drug therapy could be instituted to achieve the treatment goals in the intervention group: serum total cholesterol below 6.0 mmol L-1, no smoking, and HbA1c below 6.0%. Diastolic blood pressure below 90 mmHg was the treatment goal in both groups.
Main Outcome Measurements:
Serum cholesterol, HbA1c, diastolic blood pressure, smoking. Cardiovascular end-points were recorded.
Results:
The net changes were (change intervention--change usual care): serum cholesterol -5.0% (95% confidence interval, -7.6 to -2.3%), 17.6% more stopped smoking (P = 0.04); diastolic blood pressure and HbA1c remained unchanged. The incidence of stroke was lower in the intervention group compared with the usual-care group: 2.0 and 6.7%, respectively (P = 0.017).
Conclusion:
The intervention programme was comparatively successful with regards to the effects on hypercholesterolaemia and smoking habits. An unexpected decrease in the stroke incidence was observed in the intervention group compared with the usual-care group.