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Mortality rates in treated hypertensive men with additional risk factors are high but can be reduced: a randomized
B Fagerberg1, J Wikstrand, G Berglund
1Department of Medicine, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden. bjorn.fagerberg@medfak.gu.se
Insights
A multifactorial intervention program significantly reduced cardiovascular events and mortality in hypertensive men with high cardiovascular risk. This dedicated risk factor management improved patient prognosis.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Research
Background:
- Hypertensive patients aged 50-72 with additional risk factors (high cholesterol, diabetes, smoking) face significant cardiovascular risk.
- Existing clinical practice may not adequately address multifactorial risk in this high-risk population.
Purpose of the Study:
- To assess the feasibility and efficacy of a comprehensive, multifactorial risk factor intervention program.
- To evaluate the impact of this intervention on cardiovascular outcomes and mortality.
Main Methods:
- Randomized controlled trial comparing multifactorial intervention (diet, smoking cessation, pharmacotherapy) with usual care.
- Inclusion criteria: treated hypertensive men (50-72 years) with hypercholesterolemia, diabetes, or smoking history.
- Median follow-up of 6.6 years.
Main Results:
- The intervention group showed a significant reduction in all-cause mortality (16.2% vs 25.1%) and overall cardiovascular events (29% lower risk).
- Intervention led to significant reductions in total cholesterol (6.3%) and LDL cholesterol (9.1%).
- Smoking cessation rates were higher in the intervention group (28% vs 11% at 3 years).
Conclusions:
- A dedicated multifactorial risk factor intervention program can improve the prognosis for hypertensive patients at high cardiovascular risk.
- Intensive management of cholesterol, blood glucose, and smoking cessation is crucial for this population.
- The study demonstrates the effectiveness of a structured approach to cardiovascular risk reduction.
Abstract:
The aim was to examine the feasibility and efficacy of a multifactorial risk factor intervention program in hypertensive patients at high cardiovascular risk. Treated hypertensive men, aged 50 to 72 years, with at least one of the following: serum cholesterol concentration > or = 6.5 mmol/L, diabetes mellitus, or smoking were randomized to multifactorial risk factor intervention (n = 253) or usual care (n = 255). The specific intervention was based on group meetings to encourage a lipid lowering diet and smoking cessation. Cholestyramine, nicotinic acid, fibrates, and later statins were used either as single drug therapy or in combination, following agreed guidelines in patients in whom the nonpharmacological intervention was judged to be insufficient. Usual care was given according to clinical practice. The median follow-up time was 6.6 years. Sixty-four patients (25.1%) died in the usual care group, compared with 41 patients (16.2%) in the intervention group (P = .016; 95% confidence interval, relative risk 0.42 to 0.92). The overall risk for fatal and nonfatal cardiovascular events was 29% lower in the intervention group than in the usual care group (P = .041). Relative to usual care, the intervention program lowered mean in-trial serum concentrations of total cholesterol (6.3%, P < .0001), LDL cholesterol (9.1%, P < .0001), and blood glucose (0.2 mmol/L, P < .05). Among smokers, at entry, cotinine-adjusted quit rates were 28% in the intervention group and 11% in the usual care group (P = .012) after 3 years. This study illustrates the very high cardiovascular risk in hypertensive patients 50 to 72 years of age with additional risk factors. The results indicate, however, that the gloomy prognosis may be improved by a dedicated risk factor intervention program.