HYPERTENSION IN MIDDLE-AGED MEN - MANAGEMENT, MORBIDITY AND PROGNOSTIC FACTORS DURING LONG-TERM HYPERTENSIVE CARE

Abstract

The effects of long-term (10 years) management at a special out-patient hypertension clinic with respect to dropout rate, side effects, blood pressure (BP) control, target organ involvement, prognostic factors and cardiovascular morbidity have been studied in 686 middle-aged male hypertensives. The impact of antihypertensive treatment, as one ingredient of multiple risk factor intervention, on mortality and morbidity in an urban, male population have been analysed. The hypertensive patients were derived from a random sample of men, aged 47-54 years at entry, constituting the intervention group (n = 7,455) of a multifactorial primary prevention trial. The whole population sample was studied regarding the effect of treatment on morbidity. The 10-year drop-out rate (declined follow-up/unknown reasons) was low (5%) being highest during the first year. The frequency of severe adverse drug effects was low (3% per year) after the initial period when treatment was started. An acceptable BP reduction was achieved in the majority of patients, but in many cases first after a few years'' treatment and requiring combination drug therapy. Two-thirds of the patients achieved the goal BP (i.e. < 160/95 mm Hg). These results are attributed to the organisation of the clinic and emphasize the need for frequent check-ups during the early phase of treatment and an easy accessibility to nurses and physicians. Except for a significant regression of ST- and T-wave changes on the conventional ECG during the first treatment year signs of heart (conventional ECG, chest X-ray) and kidney (albuminuria, serum creatinine) involvement remained unchanged or increased slightly during follow-up. Angina pectoris (AP), intermittent claudication (IC) and congestive heart failure (CHF) were common complications. The prevalence increased steadily with an average annual incidence of 1.3% (AP), 0.6% (IC) and 0.6% (CHF). ECG signs indicating subclinical heart disease were risk factors for AP and CHF. Smoking was an independent risk factor for any one of these cardiovascular disorders. The 10-year incidence of total mortality was 11.1%, and of CHD and stroke morbidity 12.2% and 4.1%, respectively. Independent risk factors (entry variables) for CHD were diastolic BP, smoking, serum cholesterol, AP and proteinuria. A previous stroke, smoking and proteinuria were independently associated with stroke morbidity. Hence, the risk factor pattern was similar to that known to operate in the general population. In comparison with predicted incidences from a population sample in which risk factor intervention was kept at a minimum total mortality was reduced by 30%, CVD mortality by 37%, stroke morbidity by 30% and CHD morbidity by 13% above the systolic BP cut-off level for BP intervention. However, despite multiple risk factor intervention the mortality and CVD morbidity were still high in the hypertensive compared to the normotensive part of the population. This emphasizes the need for further preventive efforts in these high risk individuals.