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Outcomes from treatment. Clinical applications from recent trials
1Department of Clinical Pharmacology University of NSW, St George Hospital, New South Wales.
Insights
Aggressive blood pressure reduction is effective for diabetics, but optimal targets remain uncertain for others. Combining two or more antihypertensive drugs can achieve good blood pressure control in most patients.
Area of Science:
- Cardiology
- Hypertension Management
Background:
- Recent studies have investigated optimal blood pressure targets and the comparative effectiveness of antihypertensive drug classes.
- Cardiovascular morbidity and mortality are key outcomes influenced by hypertension management.
Purpose of the Study:
- To review recent hypertension trials and synthesize findings on blood pressure targets and drug efficacy.
- To clarify uncertainties in current hypertension treatment guidelines.
Main Methods:
- Review of recent clinical trials in hypertension.
- Analysis of data on blood pressure targets and cardiovascular event reduction.
- Synthesis of findings on the effectiveness of multiple antihypertensive drug combinations.
Main Results:
- Aggressive blood pressure reduction significantly reduces morbidity and mortality in diabetic patients.
- Optimal blood pressure targets for non-diabetic populations remain uncertain.
- Evidence regarding differential cardiovascular event reduction among antihypertensive drug classes is inconclusive.
- Achieving good blood pressure control is feasible in most hypertensive patients using two or more antihypertensive drugs.
Conclusions:
- Diabetics benefit from aggressive blood pressure lowering, but optimal targets for others require further research.
- The choice of antihypertensive drug class for cardiovascular event reduction requires more investigation.
- Combination therapy with multiple antihypertensive agents is effective for achieving blood pressure control in the majority of patients.
Background:
Several recent studies have addressed issues including the optimum blood pressure target and differences between antihypertensive drug classes in reducing cardiovascular morbidity and mortality.
Objective:
To review the results of several recent and topical hypertension trials.
Discussion:
There is remaining uncertainty about the optimal blood pressure target with the exception of diabetics in whom aggressive blood pressure reduction has been shown to be more effective in reducing morbidity and mortality than less aggressive reduction. It remains unclear whether there are differences between antihypertensive drug classes in their ability to reduce cardiovascular events. At least two studies have demonstrated that it is possible to achieve good blood pressure control in the majority of hypertensive patients if two or more antihypertensive drugs are used.