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[Arterial hypertension: current large therapeutic trials]
Insights
Lowering diastolic blood pressure by 5-6 mmHg through hypertension treatment significantly reduces stroke, coronary heart disease, and cardiovascular mortality. Ongoing trials investigate new antihypertensive drugs and effects in elderly patients.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Essential hypertension management relies on therapeutic trials and ongoing clinical research.
- Previous meta-analyses show modest blood pressure reduction significantly impacts cardiovascular outcomes.
- Current research evaluates newer antihypertensive classes against established treatments.
Purpose of the Study:
- To review ongoing clinical trials in essential hypertension.
- To analyze results from published therapeutic trials.
- To assess the efficacy of different antihypertensive treatments on hard endpoints.
Main Methods:
- Meta-analysis of 14 primary prevention trials in hypertension.
- Review of published therapeutic trial results.
- Examination of ongoing large-scale randomized controlled trials.
Main Results:
- A 5-6 mmHg diastolic blood pressure reduction lowered stroke events by 42%, coronary heart disease by 14%, and cardiovascular mortality by 21%.
- Antihypertensive treatment in elderly patients reduced non-fatal cardiovascular events but did not significantly alter cardiovascular mortality.
- Newer antihypertensive classes have not yet demonstrated benefits on hard endpoints like cardiovascular morbidity and mortality compared to beta-blockers or diuretics.
Conclusions:
- Modest blood pressure reduction is crucial for preventing cardiovascular events.
- Established treatments like beta-blockers and diuretics remain effective.
- Further research is needed to establish the long-term benefits of newer antihypertensive classes, especially in specific populations like the elderly.
Abstract:
In this review, the design and objectives of ongoing clinical trials in essential hypertension are discussed along with the main results obtained from previously published therapeutic trials. In a meta-analysis of 14 of the major primary prevention trials in hypertension, the difference in diastolic blood pressure between the intervention groups and the control groups was only 5-6 mmHg. This difference was associated with significant reductions in all stroke events (42 per cent), all coronary heart disease events (14 per cent) and in cardiovascular mortality (21 per cent). In elderly hypertensive patients, available studies have shown that antihypertensive treatment reduces the incidence of non-fatal cardiovascular events without significantly modifying cardiovascular mortality. Most of these results were obtained with beta-blockers or diuretics. Despite official recommendation as first line monotherapy, none of the three new antihypertensive classes has been shown to have beneficial effects on hard primary endpoints such as cardiovascular morbidity and mortality. Several ongoing large scale randomized controlled trials vs. beta-blockers or diuretics are addressing this important issue. Moreover, other effects of antihypertensive treatment such as the 'J-curve phenomenon', the rate of change in the carotid wall thickness or the exact beneficial effects in elderly patients are being investigated in some of these studies.