Document Detail


Distribution and determinants of cardiovascular events during 20 years of successful antihypertensive treatment.
MedLine Citation:
PMID:  9663916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To define the distribution and determinants of cardiovascular disease events among participants undergoing long-term antihypertensive therapy, and to stratify them into risk groups on the basis of pretreatment clinical profiles. DESIGN: A prospective cohort study of participants in a worksite-based antihypertensive treatment program in New York city (1973-1994). PATIENTS: We studied 8690 systematically treated patients who had at least 6 months of follow-up (average of 5.7 years) and, at entry, had had a systolic blood pressure of > or = 160 mmHg or a diastolic blood pressure of > or = 95 mmHg (after 1992 > or = 140/90 mmHg), or had been being administered antihypertensive medication. MAIN OUTCOME MEASURES: Blood pressure and incidence of morbid and mortal cardiovascular events. RESULTS: Blood pressure control (to 140 +/- 3/87 +/- 7 mmHg) was achieved by the first year and maintained through 18 years of therapy. In nearly 50,000 person-years of follow-up, there were 468 cardiovascular disease events [myocardial infarction including revascularization (282), strokes (93), congestive heart failure (30) and other cardiovascular deaths (63)]. Deaths from cardiovascular disease events accounted for 68% of all deaths. Myocardial infarction was most common throughout, but congestive heart failure incidence surpassed stroke incidence after 10 years. A scheme for risk stratification was constructed after analysis of the independent association of baseline factors and incident cardiovascular events. Upon the basis of ease of ascertainment and their demonstrated associations with occurrence of cardiovascular disease during treatment, we selected five pretreatment factors (history of heart attack, stroke, diabetes, age > or = 55 years and pulse pressure > or = 60 mmHg) to stratify patients into four groups. Those with no risk factor had a low risk (n=2999), those with one had a moderate risk (3042), those with two had a high risk (2237), and those with three or more had a very high risk (412). Overall, the unadjusted rates of incidence of cardiovascular disease events per 1000 person-years for patients in very high and low risk groups differed by factors of six and 14 for men and women, respectively. CONCLUSION: These results demonstrate that long-term control of blood pressure can be achieved in a general population. Nevertheless, cardiovascular disease events still accounted for most morbidity and mortality among these 'recovered' hypertensive patients. At entry, on the basis of readily identifiable characteristics, it was possible to stratify patients according to likelihood of subsequent events occurring despite control of blood pressure. This scheme could provide the basis for targeting more aggressive therapy where the potential for further cardioprotection is greatest.
Authors:
M H Alderman; H Cohen; S Madhavan
Related Documents :
20695936 - Urine albumin excretion, within normal range, reflects increasing prevalence of metabol...
8813446 - Von willebrand factor and soluble e-selectin in hypertension: influence of treatment an...
25349666 - Influence of breathing movements and valsalva maneuver on vena caval dynamics.
10353296 - Heart rate as a risk factor for atherosclerosis and cardiovascular mortality: the effec...
9090656 - The dopaminuric response to high salt diet in insulin-dependent diabetes mellitus and i...
21999196 - Influence of abcb1 (p-glycoprotein) haplotypes on nortriptyline pharmacokinetics and no...
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of hypertension     Volume:  16     ISSN:  0263-6352     ISO Abbreviation:  J. Hypertens.     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-09-11     Completed Date:  1998-09-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  761-9     Citation Subset:  IM    
Affiliation:
Albert Einstein College of Medicine, Department of Epidemiology & Social Medicine, Bronx, New York 10461, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Cohort Studies
Female
Heart Diseases / epidemiology*,  etiology
Humans
Hypertension / drug therapy*
Incidence
Male
Middle Aged
New York City / epidemiology
Prognosis
Risk Factors
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Risk factors for the development of hypertension: a 6-year longitudinal study of middle-aged Japanes...
Next Document:  The effect of home training with direct blood pressure biofeedback of hypertensives: a placebo-contr...