Primary Prevention of Sudden Cardiovascular Death in Hypertensive Patients: Mortality Results From the MAPHY Study

医学 美托洛尔 利尿剂 血压 噻嗪 氢氯噻嗪 内科学 猝死 心脏病学
作者
Greger Olsson,Jaakko Tuomilehto,G Berglund,Dag Elmfeldt,Ingrid Warnold,H. W. Barber,Keith Eliasson,B. Jastrup,N. B. Karatzas,J.W.H. Leer,F. Marchetta,J Ragnarsson,N M Robitaille,Liba Valkova,H. Wesseling,John Wikstrand
出处
期刊:American Journal of Hypertension [Oxford University Press]
卷期号:4 (2 Pt 1): 151-158 被引量:78
标识
DOI:10.1093/ajh/4.2.151
摘要

In a randomized primary prevention trial including 3,234 men with mild to moderate uncomplicated hypertension, the effect of the β-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 car-diovascular mortality were significantly lower for metoprolol than for diuretics, owing to fewer deaths from coronary heart disease and stroke. Of the car-diovascular 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 asso-ciated with a lesser incidence of sudden cardiovas-cular deaths than initial diuretic treatment in un-complicated hypertension. Am J Hypertens 1991;4:151–158

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