Common blood pressure treatments lower the risk of major cardiovascular events - 24/08/11

Doi : 10.1016/j.ehbc.2004.03.018

Flávio Danni Fuchs, MD, PhD : Commentary Author
Serviço de Cardiologia, Hospital de Clı́nicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Abstract

Question

What are the effects of different blood pressure lowering regimens on major cardiovascular events?

Study design

Prospectively designed meta-analysis of randomised controlled trials.

Main results

Twenty-nine RCTs with 2 to 8.4 years follow up were included in the analysis. ACE inhibitors, calcium antagonists or angiotensin-receptor blockers for high blood pressure significantly reduce the risk of major cardiovascular events compared with placebo or control (see Table 1). Setting a lower target blood pressure for treatment significantly reduces the risk of major cardiovascular events compared with setting a higher treatment target. There was no significant difference in the risk of major cardiovascular events among ACE inhibitor, calcium antagonist or diuretic/β-blocker-based treatment regimens. In general, a greater reduction of blood pressure resulted in a greater reduction in the risk of major cardiovascular events.

Table 1 Effects of different treatment regimens on blood pressure and major cardiovascular risk
Treatment regimen	No. of RCTs	Weighted mean difference in blood pressure (SBP/DBP)(mmHg)	RR for major cardiovascular events (95% CI)
Angiotensin converting enzyme inhibitors vs placebo	5	−5/−2	0.78 (0.73 to 0.83)
Calcium antagonist vs placebo	3	−8/−4	0.82 (0.71 to 0.95)
Angiotensin receptor blocker vs control*	4	−2/−1	0.90 (0.83 to 0.96)
Angiotensin receptor blocker vs calcium antagonist	5	+1/+1	0.97 (0.92 to 1.03)
Angiotensin converting enzyme inhibitor vs diuretic or β blocker	6	+2/0	1.02 (0.98 to 1.07)
Calcium antagonist regimens vs diuretic or β blocker	9	+1/+1	1.04 (1.00 to 1.09)
Lower vs higher target blood pressure	4	−4/−3	0.85 (0.76 to 0.95)
*The comparison pooled trials where either some or all people in the non-angiotensin-receptor blocker group received active treatment.

Authors’ conclusions

All widely used blood pressure lowering treatments reduce the risk of major cardiovascular events. A greater reduction in blood pressure leads to a greater reduction in the risk of major cardiovascular events.

Le texte complet de cet article est disponible en PDF.

Keywords : Hypertension, Drug therapy, Cardiovascular diseases, Treatment outcome, Meta-analysis

Plan

Commentary

Study parameters

Abstracted from: Turnbull F. Effects of different blood-pressure-lowering treatments on major cardiovascular events: results of prospectively designed overviews of randomised trials. Lancet 2003; 362: 1527–1535.

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Vol 8 - N° 3

P. 153-155 - juin 2004 Retour au numéro

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Common blood pressure treatments lower the risk of major cardiovascular events - 24/08/11

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