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Key messages
Hypertension is a prevalent (10-20%) and important risk factor for cardiovascular disease.
In controlled trials over 3-5 years drug treatment for hypertension prevents these complications, but little is known about long term prognosis
During 20-22 years treated hypertensive men had a significantly increased mortality, especially from coronary heart disease, compared with non-hypertensive men from the same population
The high incidence of myocardial infarction was related to organ damage, smoking, and cholesterol at the time of entry to the study, and to achieved serum cholesterol concentrations during follow up
The poor prognosis for mortality from coronary heart disease is dependent upon strict monitoring of serum cholesterol concentrations
Introduction
Treatment of hypertension prolongs life and prevents or delays congestive heart failure and nephrosclerosis and reduces the incidence of stroke. 1 5 Antihypertensive treatment has, however, been less effective in preventing coronary heart disease. 6 It is not clear whether this is due to inadequate blood pressure control, inadequate intervention of other risk factors, negative effects on the risk of cardiovascular disease from antihypertensive drugs, intervention being too late to affect atherosclerosis, or inadequate effect of present drugs on atherosclerosis.
Previous controlled trials on chronic hypertensive disease have been limited by their duration (about 5 years) as a better therapeutic effect has been suggested at later stages of treatment. 7 8 If so, important information could be gained from prospective studies of long duration, which would also allow the evaluation of patient characteristics of prognostic importance.
Our population based, prospective study of more than 20 years aimed to analyse the long term mortality in treated hypertensive men compared with non-hypertensive men taking part in the same prevention programme, and to analyse the effects of treatment on mortality from cancer and non-cardiovascular diseases.
Subjects and methods
Subjects
The multifactor primary prevention trial started in Gothenburg in 1970. The trial aimed to study whether intervention against smoking, hypercholesterolaemia, and hypertension could reduce the incidence of and mortality from cardiovascular diseases. 9 The study comprised one third of all men born between 1915 and 1925 except those born in 1922 and 1923. The intervention group comprised 9998 men and two control groups of 10 000 men each. The control groups will not be discussed further. The first screening took...