The effects of delayed BP lowering treatment on long-term all-cause and CVD mortality did not vary with baseline risk of CVD .
The review showed no clinical ly adverse ‘ legacy effect ’ on mortality or major CVD event from not treating middle-aged adults at a systolic BP threshold of 140 mmHg or over .
Although these studies are non-r and omised post-hoc analyses , they may allay concerns that early treatment of elevated systolic BP is necessary to prevent CVD events in primary prevention population
To investigate if there is evidence for a ‘ legacy effect ’ for blood pressure ( BP ) lowering treatment , that is , worse health outcomes from not initiating drug treatment at a systolic BP threshold of 140 mmHg in middle-age adults .
Long-term survival in the randomized trial of drug treatment in mild to moderate hypertension of the Oslo study 1972-3.
BACKGROUND In the Oslo cardiovascular study of 1972 - 3 a 5-year r and omized trial in mild to moderate hypertension was performed . Several changes in treatment practice s have been recommended since that time . We followed the mortality patterns up to 40 years . METHODS Invited to the Oslo study screening were 25,915 middle-aged men and 16,203 ( 63 % ) participated . Reexaminations were done to select suitable participants into the trial . Men had blood pressure 150 - 179/95 - 109 mm Hg and the active group ( n=406 ) was treated with thiazides , alpha-methyldopa and propranolol versus untreated controls ( n=379 ) . Cox regression analysis was used for statistical analyses . RESULTS There was no trend towards reduction in total mortality by treatment . A nominally significant increase in risk of death at first myocardial infa rct ion was observed in the trial treatment group across the follow-up period , HR=1.51 ( 1.01 - 2.25 ) ; ( P=0.042 ) . The excess risk developed rapidly during the first 15 years , but the gap between the groups diminished to a large extent during the next 15 years , but the curves stayed at a certain distance for the last 10 years . Cerebrovascular death tended to be non-significantly reduced , HR=0.85 ( 0.52 - 1.41 ) . CONCLUSIONS Drug treatment of mild hypertensive men initiated in the 1970s did not reduce mortality at first MI or total mortality . However , during the period ( late 1980s and whole 1990s ) , when large changes in hypertension treatment practice s occurred into regimes with more use of combination therapies including metabolically neutral drugs at lower doses , beneficial effects on MI mortality could be observed
The effects of delayed BP lowering treatment on long-term all-cause and CVD mortality did not vary with baseline risk of CVD .
The review showed no clinical ly adverse ‘ legacy effect ’ on mortality or major CVD event from not treating middle-aged adults at a systolic BP threshold of 140 mmHg or over .
Although these studies are non-r and omised post-hoc analyses , they may allay concerns that early treatment of elevated systolic BP is necessary to prevent CVD events in primary prevention population
To investigate if there is evidence for a ‘ legacy effect ’ for blood pressure ( BP ) lowering treatment , that is , worse health outcomes from not initiating drug treatment at a systolic BP threshold of 140 mmHg in middle-age adults .