THE ROLE OF DIABETES-MELLITUS AND HYPERTRIGLYCERIDEMIA AS CORONARY RISK-FACTORS IN TREATED HYPERTENSION - 15 YEARS OF FOLLOW-UP OF ANTIHYPERTENSIVE TREATMENT IN MIDDLE-AGED MEN IN THE PRIMARY PREVENTION TRIAL IN GOTEBORG, SWEDEN

Objective. To analyse the importance of diabetes mellitus and hypertriglyceridaemia as potential risk factors for coronary heart disease (CHD) in middle-aged, treated hypertensive men. Design. A prospective, long-term observational study. Subjects. Derived from a random population sample-686 hypertensive men aged 47-54 years at entry-followed for 15 years at a special out-patient hypertension clinic. Intervention and outcome measures. The patients were mainly treated with beta-adrenoceptor blockers and/or thiazide diuretics. Cardiovascular morbidity was closely monitored during follow-up. Results. In all, 133 subjects suffered a CHD event during follow-up. The presence of diabetes mellitus at entry more than doubled the CHD risk and a 1 mmol l(-1) increment of the serum triglyceride level at entry increased the CHD risk by 21%. In multivariate analyses, smoking, the presence of diabetes mellitus at entry, serum cholesterol and signs or symptoms of hypertensive end organ damage were found to be independent risk factors for CHD. In absolute terms the existence of cardiovascular damage was of much greater prognostic importance than were the presence of various metabolic abnormalities. Of the mean in-study variables, both the average serum cholesterol level and the achieved diastolic blood pressure were significantly associated with CHD. However, new diabetes mellitus which developed during follow-up as well as mean serum triglyceride levels were not associated with CHD. Conclusions. Diabetes mellitus and hypertriglyceridaemia present at the start of treatment have a prognostic impact in treated hypertensive men, whereas when such metabolic disorders develop during drug treatment they seem to be of much less importance. Smoking and already existing evidence of hypertensive end organ damage are of utmost importance for the prognosis in this type of patient.