The effect of drug treatment of hypertension on the distribution of deaths from various causes: A study of 173 deaths among hypertensive patients in the years 1959 to 1964 inclusive

Abstract

An analysis is presented of the 173 deaths which occurred in the years 1959 to 1964 among an average population for the 6 years of 569 treated hypertensive patients. Coronary artery disease, together with sudden cardiac deaths probably, but not proved to be, due to coronary artery disease, is now the most important cause of death, together accounting for 42 per cent of all deaths or 50.9 per cent of deaths when causes not related to hypertension are excluded. Approximately half of all deaths classified as coronary occur suddenly, without known premonitory chest pain. In most cases a clear previous history of coronary artery disease is available; however, it is possible that some are arrhythmic deaths not necessarily due to coronary artery disease. The need for more detail in the documentation of such cases is stressed, and a fuller classification for future studies is proposed. Cerebrovascular deaths during the years 1959 to 1964 comprised 22.5 per cent of the total deaths, compared with 33.1 per cent in the total of treated patients in the years 1950 to 1958, and 32.0 to 39.6 per cent in two untreated series from our clinic. Taken in conjunction, with the reduced over-all mortality in treated persons, these results confirm previous reports that effective treatment decreases the incidence of cerebrovascular deaths. The percentage of deaths from unrelated causes (e.g., malignancy) for 1962–1964 was more than twice that for the previous 3 years, reflecting presumably an over-all reduction in deaths due to the vascular complications of hypertension. The mortality rate from all causes (in males and females combined) was 5.1 per cent per annum, being lowest for retinal Grade 1 patients (2.9 per cent per annum) and highest for Grade 4 patients (8.3 per cent per annum).