Hypertension, antihypertensive treatment, and sudden coronary death. The Framingham Study.

During 30 years of follow-up, there were 183 sudden deaths in men and 77 in women ages 35 to 94 years who participated in the Framingham Study. Risk of sudden death was increased threefold in hypertensive persons but only if there was no previously diagnosed coronary heart disease. Men receiving antihypertensive treatment had more than twice the risk of sudden death compared with those who were untreated, whether or not they had prior manifestations of coronary heart disease. More than twice as many men who died suddenly were receiving antihypertensive therapy compared with those in the population at risk of the same age. In those with overt coronary heart disease, 34% of those dying suddenly were on antihypertensive treatment compared with 18% of those of the same age in the general population. Multivariate analysis taking into account the level of blood pressure, electrocardiographic abnormalities, and previously diagnosed coronary heart disease and cardiac failure, all of which are predisposing factors for sudden death, indicated a persistent increased risk of sudden death in association with antihypertensive treatment. Tests of interaction indicate that the excess sudden death risk was not confined to those with electrocardiographic abnormalities. In women, it may be associated with diabetes. These data suggest that some feature of antihypertensive treatment as practiced in the general population may contribute to sudden death incidence in an ill-defined subgroup of hypertensive persons.