| Metoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY Study. | |
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MedLine Citation:
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PMID: 2013485 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The present study in hypertensive men (40-64 years old) with untreated diastolic blood pressure above 100 mm Hg was aimed at investigating whether metoprolol (n = 1,609) given as initial treatment would lower the risk for coronary events (sudden death and myocardial infarction) more effectively than thiazide diuretics (n = 1,625). A substantial part of this study was the metoprolol arm of the Heart Attack Primary Prevention in Hypertension (HAPPHY) study. The HAPPHY study was a pooling of the effect of different beta-blockers, mainly metoprolol and atenolol, in which no favorable effect in relative risk was observed for atenolol as compared with diuretics. In the present study, 255 patients suffered definite coronary events during follow-up; 25% of these events were fatal, 39% were acute myocardial infarctions, and 36% were silent myocardial infarctions. The risk for coronary events was significantly lower in patients on metoprolol than in patients on diuretics (111 versus 144 cases, p = 0.001, corresponding to 14.3 versus 18.8 cases/1,000 patient years and a relative risk of 0.76 at the end of the trial; 95% confidence interval 0.58-0.98). This difference in risk has potentially important implications for clinical practice because of the large number of hypertensive patients who are at increased risk for coronary events. Because a placebo group, for ethical reasons, could not be included, relative risk can only be expressed in relation to diuretics. There was no difference between the two treatment groups in baseline characteristics, blood pressure during follow-up, or stroke rates. Thus, the difference in risk for coronary events is probably mediated via mechanisms other than blood pressure control. However, present data might suggest that different beta-blockers may have different efficacy in preventing coronary events. The reasons for this possibility are as yet unknown. |
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Authors:
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J Wikstrand; I Warnold; J Tuomilehto; G Olsson; H J Barber; K Eliasson; D Elmfeldt; B Jastrup; N B Karatzas; J Leer |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Hypertension Volume: 17 ISSN: 0194-911X ISO Abbreviation: Hypertension Publication Date: 1991 Apr |
Date Detail:
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Created Date: 1991-05-13 Completed Date: 1991-05-13 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7906255 Medline TA: Hypertension Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 579-88 Citation Subset: IM |
Affiliation:
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Department of General Practice, University of Glasgow, Scotland. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Benzothiadiazines* Blood Pressure Cardiovascular Diseases / mortality, physiopathology Coronary Artery Bypass Coronary Disease / mortality, physiopathology Diuretics Humans Hypertension / drug therapy*, mortality, physiopathology Male Metoprolol / therapeutic use* Middle Aged Risk Factors Smoking / mortality Sodium Chloride Symporter Inhibitors / therapeutic use* Survival Analysis |
| Chemical | |
Reg. No./Substance:
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0/Benzothiadiazines; 0/Diuretics; 0/Sodium Chloride Symporter Inhibitors; 37350-58-6/Metoprolol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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