Survival in patients with hypertension treated in primary careA population-based follow-up study in the Skaraborg Hypertension and Diabetes Project

OBJECTIVE: To explore risk factors for all-cause mortality in patients with hypertension. DESIGN: Community-based cohort study. SETTING: Hypertension outpatient clinic in primary health care. SUBJECTS: Hypertensive men and women who consecutively underwent an annual follow-up during 1992--1993 (n =894). METHODS: Vital status was ascertained up to December 1999 by record linkage with national registers. Gender-specific predictors for mortality from baseline examination were analysed by Cox regression. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: In both sexes all-cause mortality was predicted by fasting blood glucose (RR by 1 mmol L(-1): 1.2, CI: 1.1-1.3 in men; 1.2, 1.1-1.4 in women), and known type 2 diabetes (RR: 1.9, CI: 1.3-2.9 in men; 2.5, 1.7-3.9 in women). In men, furthermore, mortality was predicted by previous cardiovascular disease, left ventricular hypertrophy and microalbuminuria, whilst in women mortality was predicted by high blood pressure and dyslipidemia. In patients without known diabetes male gender was a strong predictor of mortality (RR: 2.0, CI: 1.4-2.9), whereas in patients with hypertension and type 2 diabetes combined, male gender was not associated with increased mortality (RR: 1.4, CI: 0.9-2.2). CONCLUSION: Type 2 diabetes in hypertensive patients treated in primary care predicts mortality and dilutes gender difference in survival. For hypertensive patients general practitioners should be observant regarding disturbed glucose metabolism and regarding the associated major risk increase in women.