Effects of Treatment on Morbidity in Hypertension

Abstract

Additional data are presented from the Veterans Administration Cooperative Study with respect to the 194 control and 186 treated male patients with initial diastolic blood pressures averaging 90-114 mm Hg. Attack rates and effectiveness of treatment were examined with respect to the following risk factors present at entry: (1) cardiovascular-renal (CVR) abnormalities, the prevalence of which was higher than in the general population of hypertensive patients; (2) diastolic blood pressure; and (3) age. Both attack rates and effectiveness of treatment increased directly with the number of these risk factors present at entry. Age and presence of CVR abnormalities at entry appeared to strongly influence subsequent attack rates, whereas entry level of blood pressure had a relatively smaller effect on attack rates. On the other hand, "effectiveness of treatment" appeared to be most influenced by the initial level of blood pressure. Patients with prerandomization diastolic blood pressure in the range of 90 to 104 mm Hg derived relatively little benefit from treatment unless they had CVR abnormalities at entry or were over 50 years of age. A longer period of follow-up would be needed to assess the value of treatment in the lower risk subgroups. With respect to side effects, the incidence of mild hypokalemia, hyperuricemia, and elevated fasting blood sugar was significantly higher in the treated group. These and other side effects should be weighed against the benefit to be expected from treating hypertensive patients at low risk.