Thromboatherosclerotic complications in hypertensives: results of the Stockholm Metoprolol (secondary prevention) Trial

Abstract

The outcome of postinfarction patients with a history of hypertension who participated in a randomized, double-blind, secondary prevention study with metoprolol or placebo treatment for 3 years has been evaluated. There were 41 patients in the placebo group and 35 patients in the metoprolol group. Elevated blood pressure was treated primarily by the addition of thiazide diuretics. Blood pressures were nearly identical in the two treatment groups. During the 3 years, 11 patients died in the placebo group and seven died in the metoprolol group. Occurrence of nonfatal events was also higher in the placebo than in the treated group: 12 patients vs one patient for reinfarction (p less than 0.005), three patients vs no patients for coronary artery bypass grafting, four patients vs no patients for cerebrovascular events, and one patient vs no patients for lower limb amputation. The total number of patients with any event was 24 vs eight (p less than 0.01). The present results may imply that treatment after infarction with metoprolol reduces nonfatal thromboatherosclerotic complications, especially nonfatal reinfarctions, in patients with a history of hypertension. However, inasmuch as the results were obtained from a retrospective subgroup analysis, they must be interpreted with caution.