Secular Trends in Long-term Sustained Hypertension, Long-term Treatment, and Cardiovascular Mortality: The Framingham Heart Study 1950 to 1990

Abstract

Background Cardiovascular morbidity and mortality result from the chronic processes involved in hypertension. However, long-term sustained (LTS) hypertension has received little attention. Methods and Results Trends in the prevalence of LTS hypertension and its treatment were assessed in 1950, 1960, and 1970 among three cohorts of men and women in the Framingham Heart Study (Mantel-Haenszel test). Cardiovascular disease (CVD) incidence and mortality were compared between patients with LTS hypertension with and without long-term treatment by use of the χ 2 test. Cox proportional hazards regression analysis was used to estimate 10-year risk of death as a function of risk factor levels and treatment. Prevalence of LTS hypertension rose from 138 to 208 per 1000 between the 1950 and 1970 male cohorts ( P <.01), while prevalence fell from 253 to 198 per 1000 between the female cohorts ( P <.02). Long-term treatment increased 51% between the male cohorts and 45% between the female cohorts (both P <.001). While CVD incidence was similar (26% versus 25%), all-cause mortality was significantly lower among men with long-term treatment (31% versus 43%; P <.05), and CVD mortality was less than half (13% versus 28%; P <.01). Among treated women, all-cause mortality was 21% (versus 34%; P <.01), and CVD mortality was 9% (versus 19%; P <.01). Ten-year risk of CVD death for patients with LTS hypertension with long-term treatment compared with those without was 0.40 (95% CI, 0.27 to 0.60). Conclusions This investigation of LTS hypertension, its treatment, and its sequelae in a free-living general population confirms the reduction in CVD mortality demonstrated in more short-term clinical trials of hypertension therapy in select patient groups.