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October 2, 1987JAMA

Cardiovascular morbidity in relation to change in blood pressure and serum cholesterol levels in treated hypertension. Results from the primary prevention trial in Goteborg, Sweden

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Why the study?

Does the control of blood pressure and serum cholesterol levels reduce cardiovascular disease morbidity in treated, middle-aged hypertensive men?

Population

686 treated, middle-aged hypertensive men

Design

Cohort

Follow-up

12 years

Authors

OSO. Samuelsson

Discussion

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Implication

Supports dual risk-factor control in treated hypertensives; leaves open optimal targets and causality pending randomized trials.

Key Points

  • To assess how long-term changes in blood pressure and serum cholesterol levels relate to cardiovascular disease morbidity in treated hypertensive men.
  • Followed 686 treated, middle-aged hypertensive men over a 12-year duration in a primary prevention trial in Gothenburg, Sweden.
  • Evaluated entry levels and mean in-study levels of systolic blood pressure, diastolic blood pressure, and serum cholesterol using multivariate analysis.
  • Mean in-study blood pressure (P < .001) and serum cholesterol levels (P < .001) were significant predictors of cardiovascular disease morbidity, whereas entry levels were not significant in multivariate analysis.
  • Further reductions below threshold levels of approximately 150 mm Hg systolic and 85 mm Hg diastolic blood pressure provided no additional cardiovascular benefit.
  • Substantial reduction in cardiovascular morbidity required a simultaneous combined reduction of both blood pressure and serum cholesterol levels.

Structured PICO

Does the control of blood pressure and serum cholesterol levels reduce cardiovascular disease morbidity in treated, middle-aged hypertensive men?

P
Population
686 treated, middle-aged hypertensive men
I
Intervention
Control of blood pressure and serum cholesterol levels
O
Outcome
Cardiovascular disease (CVD) morbidityhard clinical

Combined reduction of both blood pressure and serum cholesterol is necessary to substantially reduce CVD morbidity in treated hypertensive men, with a potential J-curve effect for BP reduction.

Cite This Study

O. Samuelsson (1987) studied this question.

synapsesocial.com/papers/6a81b481db95b5f1649f1ca3https://doi.org/10.1001/jama.258.13.1768
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiovascular Morbidity in Relation to Change in Blood Pressure and Serum Cholesterol Levels in Treated Hypertension1987 · 188 citations
  2. 2Predictors of Cardiovascular Morbidity in Treated Hypertension: Results from the Primary Preventive Trial in Goteborg, Sweden1985 · 143 citations
  3. 3Mortality and Morbidity in Relation to Systolic Blood Pressure in Two Populations with Different Management of Hypertension: The Study of Men Born in 1913 and the Multifactorial Primary Prevention Trial1987 · 25 citations
  4. 4The J-shaped relationship between coronary heart disease and achieved blood pressure level in treated hypertension: further analyses of 12 years of follow-up of treated hypertensives in the Primary Prevention Trial in Gothenburg, Sweden1990 · 91 citations
  5. 5Prognostic Value of Systolic and Diastolic Blood Pressure in Treated Hypertensive Men2002 · 176 citations