מתוך medicontext.co.il
LONDON (Reuters Health) – Reduction of systolic blood pressure, not the pharmacological properties of antihypertensive drugs, is what principally accounts for reduction of cardiovascular events in treated hypertensive and high-risk patients, according to meta-analysis results reported in The Lancet for October 20. On average, all antihypertensive agents studied had similar safety and efficacy profiles.
Dr. Jan A. Staessen and colleagues from the Katholieke Universiteit Leuven in Belgium pooled data from nine randomised trials, representing 62,605 hypertensive patients, that had compared initial treatment with diuretics or beta-blockers against newer agents such as calcium-channel blockers, angiotensin converting-enzyme inhibitors, or alpha-blockers.
One trial was excluded because it did not provide information on cardiovascular mortality. In general, the analysis revealed that older types of antihypertensives were as effective as newer agents in reducing cardiovascular events. Compared with diuretics and beta-blockers, calcium-channel blockers offered greater reduction in the risk of stroke (p = 0.03) but less reduction in the risk of myocardial infarction (p = 0.01).
The investigators also performed a meta-regression analysis across 27 trials that involved 136,124 patients, including normotensive patients at high risk. "Blood pressure gradients largely accounted for most differences in outcome," Dr. Staessen's team reports. "These findings emphasise the desirability of blood pressure control."
The hypothesis that ACE inhibitors have cardiovascular protective effects beyond lowering blood pressure remains unproven, the Swedish team adds. In fact, the PROGRESS trial showed that although perindopril monotherapy reduced systolic blood pressure more than placebo did, it did not reduce the risk of cardiovascular events or recurrent stroke.
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