16 MRFIT finds special intervention has long term benefits for patients with hypertension '••• For "yperle",i,e penoll', p"tumtICo/ogiclll t"ertlJlJ1 combilled wit" life-,tyle co"",eli"g to improve eati"g habits, lower ,erum cholesterol, and tIC"kve smoki"g cessatio" may be brOildly be"eficial ill t"e lo"g term.' Follow-up of8012 men who were hypertensive at baseline in the Multiple Risk Factor Intervention trial has been extended for 3.7 years, to a total of 10.5 years. 4019 men had been randomised to a programme of special intervention while the remainder received usual care. Coronary heart disease mortality rates were 4, 26 and 15% lower in intervention recipients than usual care recipients during the trial, during posttrial follow-up and during the full 10.5 years of follow-up, respectively. For the same follow-up periods, cerebrovascular mortality rates were 6% higher, 25% lower and II % lower in intervention recipients while all cause mortality rates were 1 % higher, 23% lower and II % lower than in usual care recipients. During the trial extension, favourable trends for special intervention over usual care were continued from the original follow-up for men with untreated diastolic BPs of Hg at baseline, for those receiving antihypertensives at ba$Cline and for those without ECG abnormalities at baseline. Unfavourable effects of special intervention in men with untreated diastolic BPs of 90-99mm Hg at baseline and those with ECG abnormalities at baseline were reversed (although not abolished) during extended follow-up. Thus, the long term follow-up indicates that the trial interventions are beneficial, particularly in patients with severe hypertension. The authors suggest that the increased benefit from intervention seen during extended follow-up may reflect favourable effects resulting from a change in the trial diuretic from hydrochlorothiazide or chlorthalidone to chlorthalidone only, which occurred·5 yeaTS into·the·trial:-Other - explanations include delayed benefits from cholesterol reduction and smoking cessation. [See also Viewpoints section, this issue, p4] Multiple Risk Factor Trial Intervention Research Group. Monality after 10'h years for hypcnensive panicipants in the Multiple Risk Factor Intervention Trial. Circulation 82: 1616-1628. Nov 1990 ,,,. 26 J .. 1991 INPHARMA® ISSN 0156-2703/9//0126-0016/0101.00/0 "Adis IIII"7111liolllll LId

MRFIT finds special intervention has long term benefits for patients with hypertension

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MRFIT finds special intervention has long term benefits for patients with hypertension

' ••• For "yperle",i,e penoll', p"tumtICo/ogiclll t"ertlJlJ1 combilled wit" life-,tyle co"",eli"g to improve eati"g habits, lower ,erum cholesterol, and tIC"kve smoki"g cessatio" may be brOildly be"eficial ill t"e lo"g term.'

Follow-up of8012 men who were hypertensive at baseline in the Multiple Risk Factor Intervention trial has been extended for 3.7 years, to a total of 10.5 years. 4019 men had been randomised to a programme of special intervention while the remainder received usual care.

Coronary heart disease mortality rates were 4, 26 and 15% lower in intervention recipients than usual care recipients during the trial, during posttrial follow-up and during the full 10.5 years of follow-up, respectively. For the same follow-up periods, cerebrovascular mortality rates were 6% higher, 25% lower and II % lower in intervention recipients while all cause mortality rates were 1 % higher, 23% lower and II % lower than in usual care recipients.

During the trial extension, favourable trends for special intervention over usual care were continued from the original follow-up for men with untreated diastolic BPs of ~IOOmm Hg at baseline, for those receiving antihypertensives at ba$Cline and for those without ECG abnormalities at baseline. Unfavourable effects of special intervention in men with untreated diastolic BPs of 90-99mm Hg at baseline and those with ECG abnormalities at baseline were reversed (although not abolished) during extended follow-up.

Thus, the long term follow-up indicates that the trial interventions are beneficial, particularly in patients with severe hypertension. The authors suggest that the increased benefit from intervention seen during extended follow-up may reflect favourable effects resulting from a change in the trial diuretic from hydrochlorothiazide or chlorthalidone to chlorthalidone only, which occurred·5 yeaTS into·the·trial:-Other -explanations include delayed benefits from cholesterol reduction and smoking cessation. [See also Viewpoints section, this issue, p4] Multiple Risk Factor Trial Intervention Research Group. Monality after 10'h years for hypcnensive panicipants in the Multiple Risk Factor Intervention Trial. Circulation 82: 1616-1628. Nov 1990 ,,,.

26 J .. 1991 INPHARMA® ISSN 0156-2703/9//0126-0016/0101.00/0 "Adis IIII"7111liolllll LId