Survival in treated hypertension: follow up study after two decades

BMJ 1998;317:167-171 ( 18 July )

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Survival in treated hypertension: follow up study after two decades

Ove K Andersson, associate professor, ^a Torbjörn Almgren, consultant physician, ^a Bengt Persson, associate professor, ^a Ola Samuelsson, associate professor, ^b Thomas Hedner, professor, ^c Lars Wilhelmsen, professor. ^d

^a Department of Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden, ^b Department of Medicine, Section of Nephrology, Sahlgrenska University Hospital, ^c Department of Clinical Pharmacology, Sahlgrenska University Hospital, ^d Institute of Heart and Lung Diseases, Section of Preventive Cardiology, Sahlgrenska University Hospital

Correspondence to: Dr Andersson

Objective: To compare survival and cause specific mortality in hypertensive men with non-hypertensive men derivedfrom the same random population, and to study mortality and morbidityfrom cardiovascular diseases in the hypertensive men in relationto effects on cardiovascular risk factors during 22-23 years offollowup.
Design: Prospective, population based observational study.
Subjects and methods: 686 hypertensive men aged 47-55 at screening compared with 6810 non-hypertensive men. The hypertensivemen were having stepped care treatment with either $beta$ adrenergicblocking drugs, thiazide diuretics, or combination treatment.Mortality, morbidity, and adverse effects were registered at yearlyexaminations and from deathcertificates.
Main outcome measures: All cause mortality and cause specificmortality.
Results: Treated hypertensive men had significantly impaired probability of total survival as well as survival fromcoronary heart disease and stroke. All cause mortality as wellas coronary heart disease and stroke mortality were very similarin hypertensive men and normotensive men during the first decade,but increased steadily thereafter despite continuous good bloodpressure control. Smoking, signs of target organ damage, and highserum cholesterol levels, but not blood pressure at screening,were significantly related to the incidence of coronary heartdisease during follow up. In time dependent Cox's regression analysis,the incidence of coronary heart disease was significantly relatedonly to serum cholesterol concentrations in the study. Cancermortality was almost similar in treated hypertensive men (61/686,8.9%) and non-hypertensive men (732/6810, 10.8%).
Conclusion: Treated hypertensive men had impaired survival and increased mortality from cardiovascular disease comparedwith non-hypertensive men of similar age. These differences wereobserved during the second decade of follow up. During an observationperiod of 22-23 years $---$ about 15 000 patient years $---$ hypertensivemen receiving diuretics and $beta$ blockers had no increased risk ofcancer or non-cardiovasculardisease.

Key messages

Hypertension is a prevalent (10-20%) and important risk factor for cardiovascular disease.
In controlled trials over 3-5 years drug treatment for hypertension prevents these complications, but little is known about long term prognosis
During 20-22 years treated hypertensive men had a significantly increased mortality, especially from coronary heart disease, compared with non-hypertensive men from the same population
The high incidence of myocardial infarction was related to organ damage, smoking, and cholesterol at the time of entry to the study, and to achieved serum cholesterol concentrations during follow up
The poor prognosis for mortality from coronary heart disease is dependent upon strict monitoring of serum cholesterol concentrations

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