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In a long term follow-up over 25 years in a general practice the observed courses of complications and deaths in a group of 704 hypertensives were recorded and compared with those that occurred in the practice as a whole over the same period. The risks to the hypertensives were calculated as ratios of the observed: expected (O/E) complications and mortalities.
Of the total number of complications and deaths (418), one half were cardiovascular and one-third were strokes.
The O/E rates for coronary artery diseases as a whole showed no extra risks for the hypertensives, but the risks for young female hypertensives were appreciably higher. The O/E rates were nearly three times higher for females. The risks of hypertensives suffering from coronary artery diseases fell with age in both sexes.
The observed rates for strokes were nearly four times greater than those expected. The O/E rates were similar in males and females. There was a decline with age.
An unexpected finding was the higher O/E rate for dementia in elderly female hypertensives.
The findings confirm the higher risks of complications and deaths for hypertensives, but within the whole spectrum of hypertension are some groups who are more vulnerable than others. These are males and those under 60 years of age. These vulnerables probably account for less than one half of all hypertensives diagnosed. It is suggested that a much more discriminating policy for the management of hypertension is accepted in order to make diagnosis and treatment of those hypertensives who really need intensive care practical, feasible, and possible.