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Is cardioprotection important in the treatment of hypertension? Considerations for the ideal agent
1University of Oxford, John Radcliffe Hospital, UK.
Insights
Antihypertensive treatments offer significant cardiovascular benefits, though less than expected. Thiazide diuretics show cardioprotection, but newer agents require more mortality data for comparison.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Antihypertensive treatment studies initially showed disappointing reductions in coronary event mortality.
- Meta-analyses reveal significant cardiovascular benefits, approximately two-thirds of expected reductions based on epidemiological data.
- Hypertension is a confirmed risk factor for cardiovascular mortality.
Purpose of the Study:
- To evaluate the effectiveness of antihypertensive treatments on cardiovascular mortality.
- To compare the mortality data of newer antihypertensive agents with thiazide diuretics.
- To resolve uncertainties regarding the impact of specific antihypertensive therapies on coronary heart disease mortality.
Main Methods:
- Meta-analysis of existing studies on antihypertensive treatment.
- Review of epidemiological data on cardiovascular risk factors.
- Analysis of available mortality data for various antihypertensive drug classes.
Main Results:
- Meta-analysis demonstrates a significant, albeit not fully expected, reduction in cardiovascular mortality with antihypertensive treatment.
- Thiazide diuretics exhibit cardioprotective effects, though their metabolic adverse effects are debated.
- Newer agents like ACE inhibitors and beta-blockers lack sufficient mortality data for definitive conclusions compared to older drugs.
Conclusions:
- The precise impact of specific antihypertensive treatments on coronary heart disease mortality remains an open question.
- There is a critical need for comparative mortality data between newer antihypertensive agents and established thiazide diuretics.
- Further research is required to establish optimal antihypertensive strategies for reducing cardiovascular mortality.
Background:
The results of many studies designed to assess the effect of antihypertensive treatment have been, at first sight, disappointing with regard to expectations of a reduction in mortality due to coronary events. However, meta-analysis shows that there is a significant benefit, which is about two-thirds of that expected from the epidemiological data.
Effects Of Thiazide Diuretics:
Older antihypertensive agents like thiazide diuretics have been shown to confer a degree of cardioprotection, although the mechanism of this effect is still unknown. Since these drugs have adverse effects on lipid and glucose metabolism, they are not (in theory) ideal agents, especially in younger patients. However, recent evidence suggests that these adverse effects may have been overemphasized.
Effects Of Newer Antihypertensive Agents:
Newer agents, such as angiotensin converting enzyme inhibitors and vasodilating beta-blockers, may have experimental and theoretical advantages over older agents but there are insufficient mortality data to allow firm conclusions.
Conclusions:
While it is clear that hypertension is a risk factor for cardiovascular mortality, the effect of specific antihypertensive treatments on coronary heart disease mortality is still unresolved. There is a critical need for data on mortality, comparing the newer agents with thiazide diuretics, now increasingly well proven.