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Cardiovascular outcomes in the comparative hypertension drug trials: more consensus than controversy

H T Ong1

  • 1HT Ong Heart Clinic, 251C Burmah Road, Penang 10350, Malaysia. htyl@pd.jaring.my

Singapore Medical Journal
|August 30, 2008
PubMed

Insights

Comparative hypertension drug trials show consistent cardiovascular protection. Lowering blood pressure, not specific drugs, explains observed benefits, emphasizing tight blood pressure control for better outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Numerous comparative antihypertensive drug trials have been conducted to evaluate cardiovascular protective efficacy.
  • Past interpretations of trial results have sometimes led to controversy regarding drug-specific benefits versus blood pressure reduction.

Purpose of the Study:

  • To reconcile apparently conflicting results from major comparative hypertension drug trials.
  • To clarify whether observed cardiovascular benefits are attributable to specific drug classes or to the degree of blood pressure reduction achieved.

Main Methods:

  • Analysis of 13 major comparative hypertension drug trials published in the last decade.
  • Inclusion of over 90% of randomized patients (168,593) from these trials.
  • Examination of both primary and secondary cardiovascular outcomes.

Main Results:

  • Eleven of the 13 trials demonstrated statistically equivalent primary cardiovascular outcomes.
  • In trials with favored secondary outcomes, significantly lower treated blood pressure was consistently observed.
  • Attributing benefits to lower achieved blood pressure unifies trial results.

Conclusions:

  • The safety and efficacy of major antihypertensive drug classes (diuretics, beta-blockers, calcium-channel blockers, ACE inhibitors, ARBs) in reducing blood pressure and cardiovascular outcomes are established.
  • Tight blood pressure control is paramount for reducing cardiovascular events.
  • Achieving optimal blood pressure control often necessitates combination therapy with multiple antihypertensive agents.

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