ANTIHYPERTENSIVE THERAPY IN DYSLIPIDEMIC MEN - EFFECTS ON CORONARY HEART-DISEASE INCIDENCE AND TOTAL MORTALITY

To investigate the influence of antihypertensive therapy and the succe ss of blood pressure control on coronary heart disease incidence and t otal mortality, we studied dyslipidemic middle-aged men participating in the placebo arm of the Helsinki Heart Study, a randomized coronary primary prevention trial with gemfibrozil. Based on blood pressure lev el and the presence of antihypertensive therapy at study entry, the pa rticipants were classified into four categories. Relative risks of cor onary heart disease (nonfatal myocardial infarction or cardiac death) and total mortality during the 5-year trial period were calculated usi ng Cox proportional hazards models. With subjects who were not using a ntihypertensive drugs and who had normal blood pressure (category I) a s reference, the relative risks of coronary heart disease during the t rial period were 2.1 (95% confidence interval [CI], 1.3 to 3.3) in unt reated hypertensive subjects (category II), 0.9 (95% CI, 0.2 to 3.8) i n subjects with successful antihypertensive therapy (category III), an d 2.0 (95% CI, 1.0 to 4.1) in subjects who remained hypertensive despi te drug therapy (category IV). The relative risks of death were 1.9 (9 5% CI, 0.9 to 3.9) in category II and 1.0 (95% CI, 0.1 to 7.3) in cate gory III; in category IV subjects, those with unsuccessful antihyperte nsive therapy, the relative risk was 4.4 (95% CI, 2.0 to 9.6). The exc ess mortality in this category was due to cardiovascular causes and wa s clustered in subjects with multiple drug therapy for hypertension co ntrol. We conclude that successful antihypertensive therapy in dyslipi demic men reduced coronary heart disease incidence despite its adverse effects on high-density lipoprotein cholesterol and triglycerides. Wi th regard to total mortality, adequate blood pressure reduction had a positive effect, and unsuccessful hypertension control increased total mortality, especially cardiovascular mortality.