MORTALITY-RATES IN TREATED HYPERTENSIVE MEN WITH ADDITIONAL RISK-FACTORS ARE HIGH BUT CAN BE REDUCED - A RANDOMIZED INTERVENTION STUDY

The aim was to examine the feasibility and efficacy of a multifactoria l risk factor intervention program in hypertensive patients at high ca rdiovascular risk, Treated hypertensive men, aged 50 to 72 years, with at least one of the following: serum cholesterol concentration greate r than or equal to 6.5 mmol/L, diabetes mellitus, or smoking were rand omized to multifactorial risk factor intervention (n = 253) or usual c are (n = 255). The specific intervention was based on group meetings t o encourage a lipid lowering diet and smoking cessation. Cholestyramin e, nicotinic acid, fibrates, and later statins were used either as sin gle drug therapy or in combination, following agreed guidelines in pat ients in whom the nonpharmacological intervention was judged to be ins ufficient. Usual care was given according to clinical practice. The me dian follow-up lime was 6.6 years. Sixty-four patients (25.1%) died in the usual care group, compared with 41 patients (16.2%) in the interv ention 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, fire intervention program lowered m ean in-trial serum concentrations of total cholesterol (6.3%, P < .000 1), LDL cholesterol (9.1%, P < .0001), and blood glucose (0.2 mmol/L, P < .05). Among smokers, at entry, cotinine-adjusted quit rates were 2 8% in the intervention group and 11% in the usual care group (P = .012 ) after 3 years. This study illustrates the very high cardiovascular r isk in hypertensive patients 50 to 72 years of age with additional ris k factors. The results indicate, however, that the gloomy prognosis ma y be improved by a dedicated risk factor intervention program. (C) 199 8 American Journal of Hypertension, Ltd.