Reduced total mortality and death from myocardial infarction and stroke in moderate/severe hypertensives treated with "Tenormin" (atenolol).

Nine hundred and thirty-nine patients with moderate to severe hypertension, observed for up to 10 years, were found to benefit from treatment with the beta1-selective agent atenolol (Tenormin), usually coprescribed with diuretics with or without vasodilators or other agents. Therapy was well tolerated, particularly when the dose of atenolol was not increased to above 100 mg/day. Left ventricular hypertrophy was reversed. Stroke mortality was reduced by about 50% from that predicted had the high blood pressure (BP) not been treated. Good control of systolic blood pressure (SBP) resulted in a reduction of total mortality and death from myocardial infarction (MI) of 40-45%, to achieve a rate similar to that on a local tolerance population (age- and sex-matched). Although treated SBP was positively correlated with significantly fewer deaths from MI and stroke, a treated SBP of less than 140 mmHg in the elderly may be associated with an increase in mortality rate from stroke. A J-curve relationship between treated diastolic blood pressure (DBP) and death from MI in hypertensive patients with accompanying overt ischaemic heart disease indicates that a treated DBP of less that about 85 mmHg is associated with an increased death rate from MI in such patients. It is therefore concluded that good control of moderate/severe hypertension significantly decreases death rate from stroke and MI. However, it is recommended that for hypertensives with co-existent overt ischaemic heart disease DBP should not be lowered to less than about 85 mmHg and, in the elderly, SBP probably should not be lowered to less than about 140 mmHg.