Coronary artery disease can be prevented by antihypertensive therapy: experiences from the MAPHY Study.
The present randomized primary prevention study in hypertensive men aged 40-64 years (n = 3,234) was aimed at investigating whether metoprolol given as initial treatment would prevent coronary artery disease (CAD) better than thiazide diuretics. Two hundred fifty-five patients had a definite CAD event during the 15,730 patient-years of follow-up; 25% of these events were fatal, and 38% were definite acute myocardial infarctions. The incidence of CAD was significantly lower during follow-up in patients randomized to metoprolol than in patients randomized to diuretics: 111 vs. 144 cases (p = 0.001). Stroke mortality was significantly lower in the metoprolol group than in the diuretic group, but the overall stroke incidence was similar in the two treatment groups. A majority of events occurred among smokers in both treatment groups although only one-third of patients were smokers at baseline. Blood pressure (BP) control was similar in the two treatment groups; therefore, the difference between the groups in CAD events is mediated via mechanisms other than the BP-reducing effect of metoprolol.
Tuomilehto
J
J
Department of Epidemiology, National Public Health Institute, Helsinki, Finland.
Wikstrand
J
J
Warnold
I
I
Olsson
G
G
Elmfeldt
D
D
Berglund
G
G
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001581:Benzothiadiazines; D002561:Cerebrovascular Disorders / Q000401:mortality; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003645:Death, Sudden; D004232:Diuretics; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D012907:Smoking / Q000009:adverse effects; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D008790:Metoprolol