Hypertension management in the Multiple Risk Factor Intervention Trial (MRFIT). Six-year intervention results for men in special intervention and usual care groups
The Multiple Risk Factor Intervention Trial was a large collaborative primary prevention trial designed to test the effects of lowering cardiovascular risk factors (i.e., diastolic blood pressure [DBP], serum cholesterol and cigarette smoking) on mortality rate from coronary heart disease in 12,866 high-risk men aged 35-57 yr. Men were randomly assigned to either special intervention (SI) or usual care (UC) groups. Usual care men were referred to their regular source of medical care. Special intervention men were seen frequently and underwent intensive intervention initially followed by maintenance intervention in 22 different clinical centers. Hypertension intervention in SI men primarily consisted of a stepped-care pharmacologic approach designed to lower blood pressure (BP). After 6 yr, 58.2% of SI men and 47.0% of UC men were given antihypertensive medication. Mean systolic and diastolic BP decreased from baseline; after 6 yr, overall DBP was 3.2 mm Hg lower in SI men compared with IU men. In hypertensive men (DBP .gtoreq. 90 mmHg or those taking antihypertensive medication at baseline), after 6 yr, DBP was 4.4 mgHg lower in the SI group compared with the UC group. Use of specific antihypertensive agents differed substantially between the 2 groups. Self-reported complaints while taking antihypertensive drugs were minimal in both groups. Weight loss was associated with BP lowering regardless of treatment status.