The Drug Treatment of Mild Hypertension in the Multiple Risk Factor Intervention Trial. A Review

Overview

Journal Drugs

Specialty Pharmacology

Date 1986 Jan 1

PMID 3720569

Citations 3

Authors

R H Grimm Jr

Affiliations

Soon will be listed here.

Abstract

The Multiple Risk Factor Intervention Trial was a long term study on the benefit of lowering risk factors for coronary heart disease mortality in middle-aged men. Study participants were randomised to either 'special intervention' or 'usual care'. Intensive intervention for special intervention men involved cholesterol lowering dietary advice, behaviour modification for cigarette smoking and a stepped care pharmacological approach to lower blood pressure. Overall, at 6 years, there was a 7.1% lower coronary heart disease mortality in special intervention compared with usual care men, a statistically non-significant difference (Confidence Interval +25 to -15%). Subgroup analysis revealed that special intervention men who were hypertensive at baseline and who had resting ECG abnormalities experienced a higher coronary heart disease mortality than the comparable usual care group. Within group Cox regression analysis, with coronary heart disease mortality as the dependent variable, revealed an interaction between diuretic use and resting ECG abnormalities in special intervention men. Additional analyses of clinics revealed a higher special intervention/usual care mortality in those clinics that used mainly hydrochlorothiazide in special intervention hypertensives. Results of the Multiple Risk Factor Intervention Trial raise important questions concerning the treatment of mild hypertension, and the clinical significance of metabolic alterations of antihypertensive drugs.

Citing Articles

Lipid profile during antihypertensive treatment. The SLIP Study Group. Study on Lipids with Isoptin Press.

LIBRETTI A, Catalano M Drugs. 1993; 46 Suppl 2:16-23.

PMID: 7512469 DOI: 10.2165/00003495-199300462-00005.

The future of pharmacological therapy for risk factor reduction. Hypertension.

Hansson L Drugs. 1988; 36 Suppl 3:110-4.

PMID: 3076114 DOI: 10.2165/00003495-198800363-00023.

Effects of treatment with verapamil SR and captopril on the lipid profile of hypertensive patients.

Catalano M, Cislaghi C, Carzaniga G, Aronica A, Seregni R, LIBRETTI A Drugs. 1992; 44 Suppl 1:88-93.

PMID: 1283590 DOI: 10.2165/00003495-199200441-00016.

References

LASSER N, Grandits G, Caggiula A, Cutler J, Grimm Jr R, Kuller L . Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial. Am J Med. 1984; 76(2A):52-66. DOI: 10.1016/0002-9343(84)90957-4. View

. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. 1979; 242(23):2562-71. View

. Randomised controlled trial of treatment for mild hypertension: design and pilot trial. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Br Med J. 1977; 1(6074):1437-40. PMC: 1607679. DOI: 10.1136/bmj.1.6074.1437. View

. Five-year findings of the hypertension detection and follow-up program. III. Reduction in stroke incidence among persons with high blood pressure. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. 1982; 247(5):633-8. View

McAlister N . Should we treat 'mild' hypertension?. JAMA. 1983; 249(3):379-82. View

Hjermann I, Velve Byre K, Holme I, Leren P . Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981; 2(8259):1303-10. DOI: 10.1016/s0140-6736(81)91338-6. View

. Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group. JAMA. 1979; 242(23):2572-7. DOI: 10.1001/jama.1979.03300230028022. View

Grimm Jr R . Should mild hypertension be treated? Early intervention. Med Clin North Am. 1984; 68(2):477-90. DOI: 10.1016/s0025-7125(16)31143-9. View

Kaplan N . Therapy for mild hypertension. Toward a more balanced view. JAMA. 1983; 249(3):365-7. View

10.

. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Am J Cardiol. 1985; 55(1):1-15. DOI: 10.1016/0002-9149(85)90290-5. View

11.

Ram C . Should mild hypertension be treated? Choosing the middle course. Med Clin North Am. 1984; 68(2):469-76. DOI: 10.1016/s0025-7125(16)31142-7. View

12.

Grimm Jr R, Leon A, Hunninghake D, Lenz K, Hannan P, Blackburn H . Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients: a double-blind controlled trial. Ann Intern Med. 1981; 94(1):7-11. DOI: 10.7326/0003-4819-94-1-7. View

13.

. Exercise electrocardiogram and coronary heart disease mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Am J Cardiol. 1985; 55(1):16-24. DOI: 10.1016/0002-9149(85)90291-7. View

14.

. Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA. 1982; 248(12):1465-77. View

15.

. The effect of treatment on mortality in "mild" hypertension: results of the hypertension detection and follow-up program. N Engl J Med. 1982; 307(16):976-80. DOI: 10.1056/NEJM198210143071603. View

16.

Cutler J, Neaton J, Hulley S, Kuller L, Paul O, Stamler J . Coronary heart disease and all-causes mortality in the Multiple Risk Factor Intervention Trial: subgroup findings and comparisons with other trials. Prev Med. 1985; 14(3):293-311. DOI: 10.1016/0091-7435(85)90058-1. View