Circulation, Vol 82, 1616-1628, Copyright © 1990 by American Heart Association
The Multiple Risk Factor Intervention Trial (MRFIT) is a randomized primary
prevention trial that tested the effect of a multifactor intervention
program on coronary heart disease (CHD) mortality in 12,866 high-risk men
aged 35-57 years. Men were randomly assigned to either a special
intervention (SI) program, which consisted of dietary advice for lowering
blood cholesterol levels, counseling aimed at cessation for cigarette
smokers, and stepped-care treatment for hypertension for those with
elevated blood pressure, or to their usual sources of health care within
the community (UC). Among the 12,866 randomized men, 8,012 (62%) were
hypertensive at baseline. For this subgroup, mortality rates with 10.5
years of follow-up were lower for the SI than for the UC group by 15% (p =
0.19) for CHD and 11% (p = 0.13) for all causes. These results reflected
more favorable outcomes for SI compared with UC hypertensive men during the
3.8 posttrial years (March 1982 through December 1985) than during the
preceding 6-8 years (through February 1982). During the posttrial years,
death rates were lower for SI than for UC men by 26% (p = 0.09) for CHD and
23% (p = 0.02) for all causes. For those with diastolic blood pressure
equal to or more than 100 mm Hg, this posttrial trend was a continuation of
a trend during the trial; therefore, with 10.5 years of follow-up, death
rates were markedly lower for SI than for UC by 36% (p = 0.07) for CHD and
50% (p = 0.0001) for all causes. Similarly, for those without baseline
resting electrocardiographic abnormalities, the favorable posttrial outcome
for the SI group was a continuation of a trend during the trial. In
contrast, for those with baseline diastolic blood pressure of 90-99 mm Hg
and for those with baseline resting electrocardiographic abnormalities, the
favorable posttrial mortality findings for the SI group were a reversal of
unfavorable trends recorded during the trial. Two factors appear to have
contributed to this more favorable mortality trend for the SI group: 1) a
change in the diuretic treatment protocol for SI men about 5 years after
randomization, which involved replacement of hydrochlorothiazide with
chlorthalidone at a daily maximum dose of 50 mg; and 2) a favorable effect
of intervention on nonfatal cardiovascular events during the trial years.
In addition, delay until the full impact of beneficial effects on mortality
end points from smoking cessation and cholesterol lowering could have
contributed.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Mortality after 10 1/2 years for hypertensive participants in the Multiple Risk Factor Intervention Trial
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