Factores predictores de riesgo de morbimortalidad en hipertensos esenciales seguidos 25 años / Risk factors for morbidity and mortality in subjects with essential hypertension, followed for 25 years

ABSTRACT

Background: Among hypertensive patients, other risk factors for mortality and morbidity, besides blood pressure, must be considered when therapeutic decisions are done. Aim: To assess the incidence and relevance of cardiovascular risk factors in a cohort of patients with essential hypertension. Material and methods: A cohort of 1.072 treated patients with essential hypertension was followed for a period up to 25 years. Four hundred eighty six were men and 586 were women, age ranged from 31 to 70 years. At entry, 56 percent of subjects did not have any organic complications associated to hypertension (stage I WHO criteria), 30 percent had mild alterations (Stage II) and 14 percent had major complications (myocardial infarction, stroke, heart failure or renal failure). Likewise, 43.8 percent had mild, 14.5 percent, moderate and 41.7 percent, severe hypertension. Patients were treated with monotherapy or combined therapy based on diuretics, beta blockers, calcium antagonists and angiotensin converting enzyme inhibitors. Goal of therapy was 140/90 mm Hg. Risk factors associated diseases and complications were registered carefully. Causes of death were obtained from hospital records and death certificates. Mortality was analyzed using life tables (intention to treat method included). Results: Blood pressure dropped significantly during follow up from a mean of 182/110 to 154/92 mm Hg. During follow up, 143 patients died and 429 complications (lethal or non lethal) were recorded. Twenty four percent of patients smoked, 24 percent reported alcohol intake, 56 percent had hypercholesterolemia, 11 percent were obese, 13 percent had diabetes and 3 percent had gout. The proportional hazard model showed that the existence of previous complications, the presence of more than 3 risk factors, and age over 60 and mean systolic and diastolic pressure during therapy, were independent and significant risk factors for mortality. Conclusions: The incidence of risk factors among our hypertensive patients is very similar to that of other national or international cohorts