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'Beyond blood pressure' means multiple risk factor intervention, not pleiotropic antihypertensive drugs

Jan A Staessen1, Lutgarde Thijs, Yan Li

  • 1Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. jan.staessen@proximus.be

Current Opinion in Cardiology
|June 9, 2007
PubMed

Insights

Newer antihypertensive drugs offer benefits beyond blood pressure lowering, but require large trials to prove. Combination therapy and lifestyle changes are key for true cardiovascular prevention in hypertension.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Antihypertensive medications are crucial for cardiovascular disease prevention.
  • Understanding drug class-specific benefits beyond blood pressure reduction is essential.

Purpose of the Study:

  • To evaluate the role of blood pressure lowering versus class-specific properties of antihypertensive drugs in cardiovascular prevention.
  • To determine the evidence for benefits beyond blood pressure reduction with newer agents.

Main Methods:

  • Review of recently published clinical trials.
  • Analysis of meta-regression studies.

Main Results:

  • Large patient numbers (150,000–180,000) and long follow-up (3–5 years) are needed to show 10–15% benefits beyond blood pressure lowering for newer drugs.
  • Newer agents may reduce new-onset diabetes mellitus by approximately 30% compared to older drugs, averting ~3 cases per 100 patients treated for 5 years.
  • Combination therapy enhances efficacy and may reduce metabolic adverse effects.

Conclusions:

  • True cardiovascular benefit in hypertensive patients stems from comprehensive risk factor intervention, not solely blood pressure reduction.
  • Optimizing treatment often involves rotating and combining drug classes for efficacy and tolerability.
  • The clinical significance of averted iatrogenic diabetes requires further investigation.
Abstract

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