EFFICACY AND TOLERANCE OF ANTIHYPERTENSIVE TREATMENT IN MEN AND WOMENWITH STAGE-1 DIASTOLIC HYPERTENSION - RESULTS OF THE TREATMENT OF MILD HYPERTENSION STUDY

Objective: To explore the sex-specific benefits and risks of treatment of stage 1 diastolic hypertension. Methods: Participants were African -American and white hypertensive men (n=557) and women (n=345) (age ra nge, 45 to 69 years) with a diastolic blood pressure less than 100 mm Hg. Participants were randomized to treatment with placebo, chlorthali done (15 mg/d), acebutolol hydrochloride (400 mg/d), doxazosin mesylat e (2 mg/d), amlodipine besylate (5 mg/d), or enalapril maleate (5 mg/d ); all were given nutritional-hygienic intervention. Results: After 4 years, women who were randomized to lifestyle intervention only were l ess likely to be receiving step 1 therapy alone (placebo) than men who were randomized to placebo therapy (46% vs 66%, respectively, P<.01). There were significantly greater decreases in the mean systolic blood pressure in both men and women who were assigned to treatment with ac tive drugs compared with those participants who were receiving placebo therapy; differences among treatments with active drugs were similar between men and women. Men experienced larger falls in their total and low-density lipoprotein cholesterol and triglyceride levels regardles s of the treatment assignment than did women; however, there were no s ignificant sex-by-treatment interactions. Quality-of-life indexes were generally improved with active drug treatment compared with placebo t herapy in both sexes; there was a sex-by-treatment interaction for the general health index. The relative risk (RR) for combined clinical ev ents was similar in women (RR, 0.64; 95% confidence interval [CI], 0.3 6 to 1.16) and in men (RR, 0.67; 95% CI, 0.40 to 1.14) who were assign ed to treatment with all active drugs combined, compared with those wh o were receiving placebo therapy. Conclusion: In these exploratory ana lyses, men and women who were assigned to treatment with active drugs experienced greater and generally similar benefits from treatment than those participants who were assigned to lifestyle intervention only.