SURVIVAL IN TREATED HYPERTENSION - FOLLOW-UP-STUDY AFTER 2 DECADES

Objective: To compare survival and cause specific mortality in hyperte nsive men with non-hypertensive men derived from the same random popul ation, and to study mortality aid morbidity from cardiovascular diseas es in the hypertensive men in relation to effects on cardiovascular ri sk factors during 22-23 years of follow up. Design: Prospective, popul ation based observational study. Subjects and methods: 686 hypertensiv e men aged 47-55 at screening compared with 6810 non-hypertensive men. The hypertensive men were having stepped care treatment with either b eta adrenergic blocking drugs, thiazide diuretics, or combination trea tment. Mortality, morbidity and adverse effects were registered at yea rly examinations and from death certificates. Main outcome measures: A ll cause mortality and cause specific mortality. Results: Treated hype rtensive men had significantly impaired probability of total survival as well as survival from coronary heart disease and stroke. All cause mortality as well as coronary heart disease and stroke mortality were very similar in hypertensive men and normotensive men during the first decade, but increased steadily thereafter despite continuous good blo od pressure control. Smoking, signs of target organ damage, and high s erum cholesterol levels, but not blood pressure at screening, were sig nificantly related to the incidence of coronary heart disease during f ollow up. In time dependent Cox's regression analysis, the incidence o f coronary heart disease was significantly related only to serum chole sterol concentrations in the study. Cancer mortality was almost simila r in treated hypertensive men (61/686, 8.9%) and non-hypertensive men (732/6810, 10.8%). Conclusion: Treated hypertensive men had impaired s urvival and increased mortality from cardiovascular disease compared w ith non-hypertensive men of similar age. These differences were observ ed during the second decade of follow up. During an observation period of 22-23 years-about 15 000 patient years-hypertensive men receiving diuretics and beta blockers had no increased risk of cancer or non-car diovascular disease.