Related Experiment Videos
Large multicentre hypertension trials
1Department of Medicine and Western Australian Heart Research Institute, University of Western Australia, Royal Perth Hospital, Australia. puddeyjb@cyllene.uwa.edu.au
Insights
Recent hypertension trials explore treatment intensity and drug classes. Aggressive blood pressure lowering is safe, with similar cardiovascular outcomes across major drug types, emphasizing blood pressure reduction itself.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Early trials established the need to treat hypertension and its efficacy in elderly patients.
- Recent research shifts focus from 'whether' to 'how' to treat hypertension.
Purpose of the Study:
- To evaluate optimal blood pressure targets and compare newer antihypertensive agents with conventional therapies.
- To assess the safety and efficacy of aggressive blood pressure lowering strategies.
Main Methods:
- Analysis of large multicentre trials, including the Hypertension Optimal Treatment (HOT) study, Captopril Prevention Project (CAPPP), and Swedish Trial in Old Patients with Hypertension-2 (STOP-2).
- Comparison of cardiovascular outcomes between different classes of antihypertensive drugs (calcium entry blockers, ACE inhibitors, beta blockers, diuretics).
Main Results:
- Aggressive blood pressure lowering to diastolic targets below 80 mmHg is safe.
- Calcium entry blockers are safe and effective as first-line antihypertensive treatment.
- Similar cardiovascular efficacy emerged for major drug classes, with blood pressure reduction being the key factor.
Conclusions:
- The degree of blood pressure lowering is paramount for cardiovascular disease prevention in hypertensive patients.
- Current evidence supports similar efficacy for major antihypertensive drug classes in achieving cardiovascular outcomes.
Abstract:
The earlier large multicentre trials in hypertensive patients addressed questions of whether mild to moderate hypertension should be treated and whether similar approaches would be effective in elderly hypertensive patients or those with isolated systolic hypertension. The research focus of recent trials has now shifted to how rather than whether such patients should be treated. Trials such as the Hypertension Optimal Treatment study attempted to discern optimal targets for long-term blood pressure control. Although unsuccessful in this primary aim, they have established the safety of aggressive blood pressure lowering to diastolic targets of less than 80 mmHg as well as the safety and efficacy of a calcium entry blocker as a first line antihypertensive approach. The Captopril Prevention Project study and Swedish Trial in Old Patients with Hypertension-2 trial focussed on whether there might be specific antiatherosclerotic advantages of the newer agents (angiotensin converting enzyme inhibitors and calcium entry blockers) over conventional therapy in comparison studies with beta blockers and diuretics. Similar efficacy for cardiovascular outcomes appears to be emerging for each of the major classes of drugs with the degree of blood pressure lowering of prime importance in cardiovascular disease prevention.