MULTIPLE CARDIOVASCULAR RISK FACTOR INTERVENTION IN TREATED HYPERTENSIVE MEN - WHAT CAN BE ACHIEVED

The objective was to develop a multifactorial intervention programme d irected towards hypercholesterolaemia, smoking, and diabetes mellitus in treated hypertensive patients and to examine its feasibility and po tential for reducing the risk of coronary heart disease. The design wa s an open, randomized, parallel-group study with allocation either a c omprehensive multiple risk factor modification programme or convention al treatment. Inclusion criteria were male sex, age 50-72 years (mean 66.4 years), treated hypertension and at least one of the following: s erum cholesterol greater-than-or-equal-to 6,5 mmol/l, smoking and diab etes mellitus. In total, 508 patients were included and 477 patients c ompleted the 1-year follow-up. The intervention programme was based on individually given advice and one information meeting followed by fiv e weekly group meetings based on nutritional advice and behavioural tr eatment principles. A similar strategy was used for smokers. If necess ary, drug therapy could be instituted to achieve the treatment goals: serum total cholesterol below 6.0 mmol/l, no smoking, and HbA1c below 6.0%. Cardioselective beta-blockers and thiazides were mainly used to achieve a diastolic blood pressure below 95 mmHg. The net changes were : serum cholesterol -5.5% [95% confidence interval (CI) -7.7% to -3.3% ], 28.0% quit smoking (P=0.0006), diastolic blood pressure -1.6 mmHg ( 95% CI -3.2 to -0.1 mmHg). Lipid-lowering drugs were used in 15% of th e patients in the intervention group at the 1-year visit. In the hyper cholesterolaemic group not using lipid-lowering agents, the net reduct ion in serum cholesterol was 6.4% (95% CI 4.0% to 8.8%). We conclude t hat the intervention programme was comparatively successful in terms o f feasibility and efficacy.