Survival and predictive clinical observations for morbidity in hypertensive patients treated for two decades. A prospective comparison with normotensive controls in the Primary Preventive Study in Gothenburg.

Objective: To analyse the effect of long-term management of hypertension on mortality and morbidity compared to non-hypertensives from the same population, and to identify clinical observations predictive of progosis in hypertensive patients treated in a specialist out-patient clinic. Design and methods: In a prospective observational study of 7495 men, aged 47-54 years, 686 (9.2%) with a mean diastolic BP of 106 mmHg at entry were treated and followed for 20-24 years. They were treated with beta-adrenergic blocking drugs and/or thiazide diuretics and vasodilators. Mortality and morbidity, routine examinations and laboratory analyses were registered at annual check-up visits. Cause specific mortality of all men was received from the Official Statistics of Sweden. Results: There was a significant increased all cause mortality in treated hypertensives compared with non-hypertensives: (42.8%) and (30.7%); odds ratio: 1.7 (95% Cl: 1.44-1.98). The increased mortality was entirely due to cardiovascular disease (CVD)(24.7%vs13.3%) dominated by coronary heart disease (CHD)(20.0%vs10.6%) while the fatal stroke incidence was lower (4.1%vs1.9%) and non-cardiovascular mortality was 18.1%vs17.4% in treated hypertensives and controls, respectively Non-smokers had the best prognosis regarding CVD; odds ratio: 0.45 (95%Cl: 0.30-0.68) and regarding CH; odds ratio: 0.50(95%Cl:0.32-0.77) while achieved systolic BP was also related to prognosis: CVD, odds ratio: 1.02(95% Cl: 1.01-1.03); CHD, odds ratio: 1.02(95%Cl: 1.01-1.32) but initial BP and cholesterol were not related to outcome among the hypertensives in a logistic regression model. Using this model for all CV morbidity, among in-study variables only achieved BP but not reversal of i.e. LVH improved the prognosis. Conclusion: Middle-aged treated hypertensive patients have a significantly impaired survival expectancy ina 20 year perspective. Smoking and target organ involvement are significantly predictive of future CVD while prognosis is somewhat improved by BP control.