title: Relationship of blood pressure to coronary and stroke morbidity and mortality in clinical trials and epidemiological studies.
abstract: We compared pooled mortality and morbidity results from nine randomized trials of antihypertensive drug treatment (total n = 43,139), in which diastolic blood pressure (DBP) was reduced by a mean of 5.8 mmHg, with mortality and morbidity differences associated with the same DBP difference in two large prospective, observational studies [the follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT) screenees and the Framingham Study]. These results indicate that the effect on stroke of BP reduction in the trials (-36%, 95% confidence interval +/- 10%) was about 80% of that estimated from the epidemiological studies, suggesting that the effects of long-term BP elevation on the cerebral vasculature are mostly reversible over 5-6 years of BP reduction. For coronary heart disease (CHD), the effect of BP reduction in the trials (-9 +/- 10%) was about 36% of that estimated from the epidemiological studies. This difference may reflect chronic processes involved in the pathophysiological association of BP with CHD; however, selective treatment of control patients at high risk of CHD and an adverse effect of diuretics on serum cholesterol may have influenced the effect of treatment in the trials.
authors.forename: S W
authors.initials: SW
authors.lastname: MacMahon
authors.forename: J A
authors.initials: JA
authors.lastname: Cutler
authors.forename: J D
authors.initials: JD
authors.lastname: Neaton
authors.forename: C D
authors.initials: CD
authors.lastname: Furberg
authors.forename: J D
authors.initials: JD
authors.lastname: Cohen
authors.forename: L H
authors.initials: LH
authors.lastname: Kuller
authors.forename: J
authors.initials: J
authors.lastname: Stamler
mesh_terms: D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D004232:Diuretics / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005544:Forecasting; D006801:Humans; D011433:Propranolol / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D011433:Propranolol