Cardiovascular mortality in hypertensive men according to presence of associated risk factors

To evaluate the risk of cardiovascular disease (CVD) mortality in hypertens ive men according to the presence of associated risk factors (ARFs). The po pulation was composed of 29 640 normotensive men without ARFs (reference gr oup) and 60 343 hypertensive men (with and without ARFs) who had a standard health checkup at the Centre d'Investigations Preventives et Cliniques bet ween 1978 and 1988. Mortality data for a mean period of 14 years were analy zed. The following ARFs were considered: total cholesterol greater than or equal to2.5 g/L, personal history of diabetes, smoking (current smokers), b ody mass index >28 kg/m(2), and heart rate >80 bpm. CVD risk related to the presence of isolated hypertension (assessed in hypertensive subjects witho ut ARFs versus the reference group) increased linearly from 15% at the age of 30 years to 134% at the age of 80 years. In hypertensive subjects, one a dditional ARF increased CVD risk by 56% (47% to 65%, P<0.01) in younger sub jects but only by 4% (-8% to 17%, P=NS) in older subjects. The role of hype rcholesterolemia and tobacco smoking in CVD mortality was significantly hig her in hypertensive subjects aged <55 years than in hypertensive subjects a ged greater than or equal to 55 years (P<0.01), whereas the roles of tachyc ardia and obesity were not affected by age. In younger hypertensive subject s, evaluation of CVD risk and therapeutic strategies should target ARFs. In older subjects, the presence of high blood pressure levels seems to be the major determinant of CVD risk.