Classes of antihypertensive medications and blood pressure control in relation to metabolic risk factors

Metabolic syndrome (MetS) is associated with uncontrolled blood pressure (BP), despite use of aggressive therapy. This study was performed to assess whether the use of different classes of antihypertensive drugs might influence this association.

We evaluated risk of uncontrolled BP (BP ≥ 140/90 mmHg under antihypertensive treatment) at the time of the last available visit, after a mean follow-up of 5 years in 4612 hypertensive patients without prevalent cardiovascular disease (43% women, 53 ± 11 years) from the Campania Salute Network.

At the time of the first visit, prevalence of MetS was associated with 43% increased risk of follow-up uncontrolled BP, independent of significant confounders and without a significant impact of specific classes of antihypertensive medications. At the time of the last available visit, patients with MetS had more often uncontrolled BP, despite more aggressive treatment. After adjusting for demographics, risk factors and number of antihypertensive medications, risk of uncontrolled BP was reduced with increased prescription of diuretics [DRTs; odds ratio (OR) 0.73, 95% confidence interval (CI) 0.62-0.86], renin-angiotensin system blockers [RAS-blockers (Angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers); OR 0.77, 95% CI 0.66-0.91] and statins (OR 0.79, 95% 0.68-0.92, all P < 0.05), without significant impact of the other classes of medications.

Despite the use of increased number of medications, hypertensive patients with MetS are at higher risk of uncontrolled BP. Among classes of antihypertensive medications, increased prescriptions of DRTs, RAS-blockers and also statins decrease the probability of poor BP control.