Veterans Administration Cooperative Studies of Hypertension

Perry Jr., H. Mitchell
November 1978
Angiology;Nov1978, Vol. 29 Issue 11, p804
Academic Journal
1. Severe untreated hypertension (diastolic pressures of 115 to 130 mm Hg), with some patients already having significant complications, was associated with an annual morbid event rate of 28%. Two-thirds of these events seemed to be primarily hypertensive events. Antihypertensive treatment aborted nearly all morbid events. 2. Untreated moderate hypertension (diastolic pressures of 105 to 115 mm Hg) was associated with an annual morbid event rate of 12%, of which half seemed to be primarily hypertensive. Antihypertensive treatment aborted about two-thirds of these morbid events, including all the hypertensive ones. 3. Although there are no hard data relating benefits of treatment to race, the available trends suggested that blacks and whites benefited equally from treatment of moderate hypertension; the benefits of treatment were minimally related to age and only slightly related to a history of prior complications. In contrast, the trend suggested that therapy benefited patients with mild hypertension (disastolic pressures 90 to 105 mm Hg) less than those with severe hypertension. However, even in mild hypertension, the apparent benefits were sufficient to be potentially very significant. 4. Among the active-drug patients, there was surprisingly little difference in the morbid event rate of those with the best and worst control of their hypertension. However, there are major uncertainities about the real pressures of these treated patients. 5. Almost 1 in 6 patients whose diastolic pressures was well controlled by treatment for at least 2 years remained normotensive for 18 months when treatment was discontinued. Moreover, of those who remained normotensive for the first 6 months, few redeveloped hypertension in the next year; thus a relatively permanent effect was suggested. The only characteristic with which such remissions could be correlated was mildness of the pretreatment hypertension. 6. With a separate study population, propranolol alone was found to be a less effective antihypertensive agent than the combination of diuretic and reserpine used for the prior study. The combination of propranolol and a diuretic or hydralazine seemed slightly less effective than reserpine plus diuretic. Only the triple combination of propranolol, hydralazine, and diuretic was as effective as reserpine and diuretic. 7. Preliminary data from a third study population, this one composed of patients with mild hypertension (diastolic pressures of 85 to 105 mm Hg), revealed no evidence of diminished morbidity and mortality in the treated (active-drug) patients. This had been predicted because of the relatively small population and short follow-up time. The treated patients, however, had the expected large number of side effects, with asthenia, aches and cramps, nasal stuffiness, impotence, and somnolence occurring three times as often as in the control (placebo) patients. The treated patients also had the expected large excess of chemical abnormalities, with hypokalemia and hyperuricemia occurring in 15 and 20% of them, respectively. In contrast, significant worsening of hypertension was confined to the control patients, among whom it developed at a rate of almost 2% per man-year of exposure. Finally and most disturbing, preliminary finds suggest treated patients may have had an unexpected excess of asymptomatic electrocardiographic arrhythmias of uncertain significance.


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