Treatment of Hypertension in the Community

The feasibility and efficacy of antihypertensive treatment within the Primary Preventive Trial against myocardial infarction and stroke in Göteborg, Sweden, are described. The study group consisted of 9967 men aged 47–54 years, chosen at random from the general population. 75% of them participated in a screening examination including a blood pressure (BP) measurement. Hypertension defined as BP above 175 mm Hg systolic or 115 mm Hg diastolic on two separate occasions or antihypertensive treatment was found in 9%. The drop‐out rate was 6.5% during the first year and 3.6% during the second year of treatment. The percentage of hypertensive subjects with uncontrolled BP decreased from 83% at screening to 16% after one year and to 9% after two years of treatment. The frequency of side‐effects of such severity as to cause withdrawal of drugs, was 16% during the first year and 7% during the second year. The morbidity in coronary heart disease and stroke in those hypertensives (n=696) treated at the Hypertension Clinic was compared with that of an untreated control group (n=330). The incidence of death and fatal plus non‐fatal myocardial infarction was significantly lower in the treated group than in the untreated comparison group, in spite of lower initially predicted risk of myocardial infarction in the comparison group. The findings indicate that antihypertensive treatment prevents the occurrence of coronary heart disease.