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(Circulation. 1996;93:638-640.)
© 1996 American Heart Association, Inc.

Articles

Have Long-term Benefits of Antihypertensive Therapy Been Underestimated?

Provocative Findings From the Framingham Heart Study

Aram V. Chobanian, MD

From the Boston (Mass) University School of Medicine.

Correspondence to Aram V. Chobanian, MD, Boston University School of Medicine, 80 E Concord St, Boston, MA 02118.

Key Words: Editorials • hypertension • trials

The article by Sytkowski et al¹ in this issue of Circulation provides an interesting analysis of secular trends of hypertension, antihypertensive therapy, cardiovascular complications, and overall mortality in the Framingham Heart Study population. Successive cohorts of men and women between the ages of 50 and 59 years were followed for a 20-year period beginning in either 1950, 1960, or 1970, thereby spanning the 40-year period during which the most important advances in the control of hypertension have been made. The authors suggest that the long-term benefits of the control of hypertension for cardiovascular disease (CVD) and total mortality may be much greater than those observed in prior shorter-term clinical trials.

These secular trend data must be interpreted with caution because of the inability to control for certain variables that could have led to unknown selection bias. The treatment was not controlled, and major changes undoubtedly occurred in drug therapy during the 40 years of follow-up, during which several new classes of antihypertensive drugs became available. The diagnostic criteria for clinical end points changed as a result of new methods that provided greater specificity and earlier recognition of CVD. Secular trends occurred in other cardiovascular risk factors, such as serum cholesterol and smoking, and in overall cardiovascular mortality during the study period. The definitions used for hypertension (systolic pressure 160 mm Hg and/or diastolic pressure 95 mm Hg) and for its control (blood pressure <160/95 mm Hg) changed nationally during the period of study, and treatment was probably initiated in some . . . [Full Text of this Article]

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