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Circulation. 1996 Feb 15;93(4):697-703.

Secular trends in long-term sustained hypertension, long-term treatment, and cardiovascular mortality. The Framingham Heart Study 1950 to 1990.

Author information

1
Framingham Heart Study, Department of Mathematics, Boston University, MA 02215, USA.

Abstract

BACKGROUND:

Cardiovascular morbidity and mortality result from the chronic processes involved in hypertension. However, long-term sustained (LTS) hypertension has received little attention.

METHODS AND RESULTS:

Trends in the prevalence of LTS hypertension and its treatment were assessed in 1950, 1960, and 1970 among three cohorts of men and women in the Framingham Heart Study (Mantel-Haenszel test). Cardiovascular disease (CVD) incidence and mortality were compared between patients with LTS hypertension with and without long-term treatment by use of the chi 2 test. Cox proportional hazards regression analysis was used to estimate 10-year risk of death as a function of risk factor levels and treatment. Prevalence of LTS hypertension rose from 138 to 208 per 1000 between the 1950 and 1970 male cohorts (P < .01), while prevalence fell from 253 to 198 per 1000 between the female cohorts (P < .02). Long-term treatment increased 51% between the male cohorts and 45% between the female cohorts (both P < .001). While CVD incidence was similar (26% versus 25%), all-cause mortality was significantly lower among men with long-term treatment (31% versus 43%; P < .05), and CVD mortality was less than half (13% versus 28%; P < .01). Among treated women, all-cause mortality was 21% (versus 34%; P < .01), and CVD mortality was 9% (versus 19%; P < .01). Ten-year risk of CVD death for patients with LTS hypertension with long-term treatment compared with those without was 0.40 (95% CI, 0.27 to 0.60).

CONCLUSIONS:

This investigation of LTS hypertension, its treatment, and its sequelae in a free-living general population confirms the reduction in CVD mortality demonstrated in more short-term clinical trials of hypertension therapy in select patient groups.

PMID:
8640998
[Indexed for MEDLINE]

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