Key Points
- To determine how baseline cardiovascular-renal abnormalities, diastolic blood pressure, and age influence clinical attack rates and therapeutic effectiveness in hypertensive men.
- Secondary analysis of the Veterans Administration Cooperative Study involving 194 control and 186 treated male patients with baseline diastolic blood pressure averaging 90–114 mm Hg.
- Patients were stratified and evaluated based on prerandomization diastolic blood pressure, age, and preexisting cardiovascular-renal abnormalities to assess attack rates, treatment efficacy, and adverse reactions.
- Clinical attack rates and treatment effectiveness increased directly with the number of baseline risk factors, with age and cardiovascular-renal abnormalities strongly predicting subsequent events, while baseline blood pressure primarily governed treatment effectiveness.
- Patients with baseline diastolic blood pressure between 90 and 104 mm Hg showed negligible benefit from treatment unless they were older than 50 years of age or had preexisting cardiovascular-renal abnormalities.
- The treated group exhibited significantly higher incidences of adverse metabolic effects, specifically mild hypokalemia, hyperuricemia, and elevated fasting blood sugar.
Structured PICO
Does antihypertensive treatment reduce morbidity in male patients with diastolic blood pressure of 90-114 mm Hg?
PPopulation380 male patients with initial diastolic blood pressures averaging 90-114 mm Hg
IInterventionAntihypertensive treatment
OOutcomeMorbidity (attack rates)
Antihypertensive treatment is most effective in patients with higher baseline diastolic blood pressure, older age, or pre-existing cardiovascular-renal abnormalities.
Limitations
- A longer period of follow-up would be needed to assess the value of treatment in the lower risk subgroups.