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Primary Prevention With Metoprolol in Patients With HypertensionMortality Results From the MAPHY Study
John Wikstrand, MD, PhD;
Ingrid Warnold, PhD;
Gunnar Olsson, MD, PhD;
Jaakko Tuomilehto, MD, PhD;
Dag Elmfeldt, MD, PhD;
Göran Berglund, MD, PhD;
the Advisory Committee;
Gunnar Olsson, MD, PhD;
Jaakko Tuomilehto, MD, PhD;
Ingrid Warnold, PhD;
John Wikstrand, MD, PhD;
Hamish J. Barber, MD;
Keith Eliasson, MD, PhD;
Birthe Jastrup, MD;
Nicholas B. Karatzas, MD;
John Leer, MD;
Fausto Marchetta, MD;
Johann Ragnarsson, MD;
Michelle Robitaille, MD;
Liba Valkova, MD;
Harry Wesseling, MD, PhD;
Robert Bergstrand, MD, PhD;
Lars Wilhelmsen, MD, PhD;
Göran Berglund, MD, PhD;
Aram Chobanian, MD;
Anders Odén, PhD;
Jonny Lindqvist;
J. George Fodor, MD, PhD;
S. Paul Handa, MD;
Gordon D. Hardacre, MD;
N. Michelle Robitaille, MD, MPH;
Robin S. Shearer, MD;
Robin C. Woollam, MD;
Frantisek Boudik, MD;
Zdenek Hejl, MD;
Zbynek Pisa, MD;
Jiri Valek, MD;
Liba Valkova, MD;
Birthe Jastrup, MD;
Matti Honkavaara, MD;
Pasi Kuusisto, MD;
Martti Mönkkönen, MD;
Arto Mönttinen, MD;
Matti Pohjola, MD;
Jaakko Tuomilehto, MD, PhD;
Seija Vinni, MD;
Olavi Vänskä, MD;
Nicholas B. Karatzas, MD;
Bart S. ten Berge, MD;
Theo H. J. J. M. Bloem, MD;
Johan Frans May, MD;
Menso J. Nubé, MD;
Jo L. J. Jansen, MD;
Thordur Hardarson, MD;
Johann R. Ragnarsson, MD;
Snorri Snorrason, MD;
Ettori Ambrosioni, MD;
Roberto Fogari, MD;
Fausto Marchetta, MD;
Anna Pirrelli, MD;
Svein Z. Bratland, MD;
Åge Dahl, MD;
Arne Haraldson, MD;
John Leer, MD;
Bernd Atmer, MD;
Agneta Brouneus, MD;
Birger Brouneus, MD;
Arne Bruhn, MD;
Jan Candefjord, MD;
Gunnar Ekblad, MD;
Keith Eliasson, MD, PhD;
Åke Ellborg, MD;
Dag Elmfeldt, MD, PhD;
Sven-Erik Fagerberg, MD, PhD;
Lars Fries, MD;
Johan Erik Frisell, MD;
Karl Gumaelius, MD;
Christer Gunnarsson, MD;
Raoul Hagströmer, MD;
Leo Hassler, MD;
Staffan Hjalmers, MD;
Kjell Hultsten, MD;
Brita Hylander, MD;
Anders Häggmark, MD;
Bertil Johansen, MD;
Jörgen Jonsson, MD;
Jan Kjellberg, MD;
Lars-Göran Lindgren, MD;
Gösta Linné, MD;
Janos Luptovics, MD;
Per-Olof Magnusson, MD;
Lennart Nilsson, MD;
Lars-Göran Persson, MD;
Åke Sjöstrand, MD;
Ted Strömvall, MD;
Tunc Tovi, MD;
Halina Wajntraub, MD;
Barry J. Adams-Strump, MD;
Steven Bird, MD;
L. Malcolm Campbell, MD;
Allan R. Cuthill, MD;
John R. Goves, MD;
Peter F. Grundy, MD;
Keith G. Harding, MD;
Robert Harvard Davis, MD;
John H. McLauchlan, MD;
Chris J. L. Morgan, MD;
Alexander L. Muir, MD;
Trevor G. Pinker, MD;
Sudhi Sudhakar, MD;
Stanley H. Taylor, MD;
Chris G. Wathen, MD
JAMA. 1988;259(13):1976-1982.
Abstract
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The present study of primary prevention in white men aged 40 to 64 years attempts to investigate whether a β-blocker given as initial antihypertensive treatment would lower total mortality to a greater extent than thiazide diuretics. Patients were randomized to metoprolol (n = 1609, 8110 patient-years) or a thiazide diuretic (n = 1625, 8070 patient-years). The median follow-up time was 4.2 years. The mean dose of metoprolol was 174 mg/d, and of thiazide diuretics, 46 mg/d of hydrochlorothiazide or 4.4 mg/d of bendroflumethiazide. Identical control of blood pressure was achieved using a fixed therapeutic schedule. Total mortality was significantly lower for metoprolol than for thiazide diuretics because of fewer deaths from coronary heart disease and stroke. Total mortality was also significantly lower in smokers randomized to metoprolol. The benefit demonstrated in patients treated with metoprolol seems to have important implications for clinical practice.
(JAMA 1988;259:1976-1982)
Author Affiliations
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Department of Medicine, Danderyd Hospital, Karolinska Institute, Stockholm; Department of Epidemiology, National Public Health Institute, Helsinki; Medical Department, Hassle Cardiovascular Research Laboratories, Mölndal Sweden; Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of General Practice, University of Glasgow, Scotland; Department of Internal Medicine, Karolinska Hospital, Karolinska Institute, Stockholm; Medical Clinic, Odder (Denmark) Sygehus; Hypertension Research Clinic, First Department of Propedeutic Medicine, Laikon Hospital, University of Athens; Legecenteret i Florvå g, Norway; Ospedale S Orsola, Bologna, Italy; Medical Department, Reykjavik (Iceland) City Hospital; Institut de Cardiologie, Quebec; Department of General Practice, National Institute of Health, Prague; Department of Pharmacology and Clinical Pharmacology, University of Groningen, The Netherlands.; Department of Internal Medicine, Eastern Hospital, Gothenburg (Sweden) University.; Department of Medicine, Malmö Hospital, Lund (Sweden) University; Cardiovascular Institute, Boston University School of Medicine.; Department of Mathematics, Gothenburg (Sweden) University.; Computing Centre, Gothenburg (Sweden) University.; Canada; Czechoslovakia; Denmark; Finland; Greece; the Netherlands; Iceland; Italy; Norway; Sweden; United Kingdom
From the Wallenberg Laboratory for Cardiovascular Research (Dr Wikstrand) and the Department of Medicine I (Drs Elmfeldtand Berglund), Sahlgrenska University Hospital, Gothenburg, Sweden; the Medical Department, AB Hässle, Mölndal, Sweden (Dr Warnold); the Department of Internal Medicine, Danderyd Hospital, Karolinska Institute, Stockholm (Dr Olsson); and the Department of Epidemiology, National Public Health Institute, Helsinki (Dr Tuomilehto). Dr Berglund is now with the Department of Medicine, Malmö Hospital, Lund (Sweden) University. See the acknowledgements for a listing of the members of the Advisory Committee.
Footnotes
Reprint requests to Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Hospital, S-413 45 Gothenburg, Sweden (Dr Wikstrand).
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