Document Detail

Primary prevention of sudden cardiovascular death in hypertensive patients. Mortality results from the MAPHY Study.
MedLine Citation:
PMID:  2021446     Owner:  NLM     Status:  MEDLINE    
In a randomized primary prevention trial including 3,234 men with mild to moderate uncomplicated hypertension, the effect of the beta-blocker metoprolol or a thiazide diuretic as an initial antihypertensive therapy was compared regarding the risk of sudden cardiovascular death during a follow-up ranging from 2.3 to 10.8 years (median of 4.2 years). Only men aged 40 to 64 years were included in the study. The randomization of patients into the metoprolol (n = 1,609) or diuretic group (n = 1,625) was performed after stratification for age, smoking habits, serum cholesterol, and systolic blood pressure. At baseline the two treatment groups were well matched. Metoprolol was given in a mean dose of 174 mg daily and the mean dose of thiazide diuretic was either 46 mg hydrochlorothiazide daily or 4.4 mg bendroflumethiazide daily. Identical blood pressure control was achieved using the fixed therapeutic schedule. Total and cardiovascular mortality were significantly lower for metoprolol than for diuretics, owing to fewer deaths from coronary heart disease and stroke. Of the cardiovascular deaths, 78% were classified as sudden cardiovascular deaths (occurred within 24 h after the onset of symptoms). There were significantly fewer sudden cardiovascular deaths in the metoprolol group compared to the diuretic group (32 v 45, P = .017). The present results suggest that initial antihypertensive therapy with metoprolol is associated with a lesser incidence of sudden cardiovascular deaths than initial diuretic treatment in uncomplicated hypertension.
G Olsson; J Tuomilehto; G Berglund; D Elmfeldt; I Warnold; H Barber; K Eliasson; B Jastrup; N Karatzas; J Leer
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of hypertension     Volume:  4     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  1991 Feb 
Date Detail:
Created Date:  1991-06-06     Completed Date:  1991-06-06     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  151-8     Citation Subset:  IM    
Department of General Practice, University of Glasgow, Scotland.
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MeSH Terms
Arteriosclerosis / drug therapy,  prevention & control
Bendroflumethiazide / therapeutic use
Death, Sudden / epidemiology,  etiology*
Follow-Up Studies
Hydrochlorothiazide / therapeutic use
Hypertension / complications,  drug therapy,  mortality*
Metoprolol / therapeutic use*
Middle Aged
Sodium Chloride Symporter Inhibitors / therapeutic use*
Reg. No./Substance:
0/Diuretics; 0/Sodium Chloride Symporter Inhibitors; 37350-58-6/Metoprolol; 58-93-5/Hydrochlorothiazide; 73-48-3/Bendroflumethiazide

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

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