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Primary Prevention With Metoprolol in Patients With Hypertension:  Mortality 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; 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; 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; Matti Honkavaara, MD; Pasi Kuusisto, MD; Martti Mönkkönen, MD; Arto Mönttinen, MD; Matti Pohjola, MD; Seija Vinni, MD; Olavi Vänskä, 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; Anna Pirrelli, MD; Svein Z. Bratland, MD; Åge Dahl, MD; Arne Haraldson, MD; Bernd Atmer, MD; Agneta Brouneus, MD; Birger Brouneus, MD; Arne Bruhn, MD; Jan Candefjord, MD; Gunnar Ekblad, MD; Åke Ellborg, MD; 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 ; the Advisory Committee
JAMA. 1988;259(13):1976-1982. doi:10.1001/jama.1988.03720130040027.
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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)


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