INFLUENCE OF PHARMACOLOGICAL TREATMENT AND RISK-FACTORS ON MORTALITY OF HYPERTENSIVE PATIENTS

Background: The V JNC consensus stated that although new antihypertens ive agents, such as angiotensin converting enzyme inhibitors and calci um channel blockers, are considered safer drugs, there is no firm evid ence from large controlled trials that these drugs are associated with a lower cardiovascular mortality. Aim: To study the association betwe en cardiovascular risk factors, blood pressure levels, pharmacological treatment and mortality in a group of hypertensive patients followed at an hypertension outpatient clinic. Patients and methods: Patients w ith essential hypertension were treated with different antihypertensiv e medications, according to Physicians criteria, and controlled until death or loss from follow up. Causes of death were obtained from hospi tal records and death certificates. Survival was analyzed using life t ables, comparisons between groups of patients were done using chi squa re or a Cox's proportional hazards model. Results: Three hundred thirt y nine hypertensive patients aged 33 to 80 years old were followed for a mean period of 9.8 +/- 4.9 years. Eighty six were treated with beta blockers, 64 with diuretics, 133 with calcium antagonists and 56 with ACE inhibitors. Blood pressure dropped similarly with all medications . During follow up, 79 patients died. Life table analysis showed that patients with a history of angina, diabetes or myocardial infaraction had higher mortality rates. Similarly, patients treated with beta bloc kers and diuretics had higher mortality than patients treated with cal cium antagonists or angiotensin converting enzyme inhibitors. The prop ortional hazards model showed that the effect of treatment modality pe rsisted after correction for the other risk factors for mortality. Con clusions: In this series of hypertensive patients, those treated with beta blockers ol diuretics had higher mortality rates than those recei ving calcium channel antagonists or angiotensin converting enzyme inhi bitors.