Survival in treated hypertension: follow up study after two decades.
OBJECTIVE
To compare survival and cause specific mortality in hypertensive men with non-hypertensive men derived from the same random population, and to study mortality and morbidity from cardiovascular diseases in the hypertensive men in relation to effects on cardiovascular risk factors during 22-23 years of follow up.


METHODS
Prospective, population based observational study.


METHODS
686 hypertensive men aged 47-55 at screening compared with 6810 non-hypertensive men. The hypertensive men were having stepped care treatment with either beta adrenergic blocking drugs, thiazide diuretics, or combination treatment. Mortality, morbidity, and adverse effects were registered at yearly examinations and from death certificates.


METHODS
All cause mortality and cause specific mortality.


RESULTS
Treated hypertensive men had significantly impaired probability of total survival as well as survival from coronary heart disease and stroke. All cause mortality as well as coronary heart disease and stroke mortality were very similar in hypertensive men and normotensive men during the first decade, but increased steadily thereafter despite continuous good blood pressure control. Smoking, signs of target organ damage, and high serum cholesterol levels, but not blood pressure at screening, were significantly related to the incidence of coronary heart disease during follow up. In time dependent Cox's regression analysis, the incidence of coronary heart disease was significantly related only to serum cholesterol concentrations in the study. Cancer mortality was almost similar in treated hypertensive men (61/686, 8.9%) and non-hypertensive men (732/6810, 10.8%).


CONCLUSIONS
Treated hypertensive men had impaired survival and increased mortality from cardiovascular disease compared with non-hypertensive men of similar age. These differences were observed during the second decade of follow up. During an observation period of 22-23 years-about 15 000 patient years-hypertensive men receiving diuretics and beta blockers had no increased risk of cancer or non-cardiovascular disease.
Department of Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden.
O K
OK
Andersson
T
T
Almgren
B
B
Persson
O
O
Samuelsson
T
T
Hedner
L
L
Wilhelmsen
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001581:Benzothiadiazines; D001794:Blood Pressure; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D004232:Diuretics; D004338:Drug Combinations; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D016019:Survival Analysis; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D001581:Benzothiadiazines; D004232:Diuretics; D004338:Drug Combinations; D049993:Sodium Chloride Symporter Inhibitors; D002784:Cholesterol