doi: 10.1161/CIRCULATIONAHA.105.588020
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(Circulation. 2006;113:2754-2774.)
© 2006 American Heart Association, Inc.
Controversies in Cardiovascular Medicine |
Management of hypertension: is it the pressure or the drug?
Blood Pressure Reduction Is Not the Only Determinant of Outcome
From Imperial College, London, UK (P.S.S., N.R.P.), and the Department of Preventive Medicine, RUSH Medical College of RUSH University at RUSH University Medical Center, Chicago, Ill (W.J.E., M.C.J., H.R.B.).
Correspondence to Professor Peter Sever, International Centre for Circulatory Health, Imperial College London, 59 N. Wharf Rd, London, W2 1PG, UK (e-mail p.sever@imperial.ac.uk), or William J. Elliott, MD, PhD, 1700 W. Van Buren, Suite 470, Chicago, IL 60612 (e-mail welliott@rush.edu).
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Whether certain classes of antihypertensive drugs confer benefits beyond those associated with lowering blood pressure remains a highly controversial issue. Data from several meta-analyses have been used to support the notion that most, if not all, of the cardiovascular benefits reported with the use of different classes of antihypertensive drugs are simply a consequence of the extent to which they lower blood pressure. However, we submit evidence in this review that the diverse pharmacological actions of several antihypertensive medications may have benefits beyond their blood pressure–lowering effects and that, in the case of certain classes of drugs, notably ß-blockers, adverse metabolic effects of these drugs may actually mitigate the potential benefits of blood pressure lowering.
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The Early Placebo-Controlled Hypertension Trials and the Shortfall in Coronary Heart Disease Prevention |
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The early placebo-controlled trials of the treatment of hypertension, several of which were undertaken in high-risk patient populations, provided convincing evidence for substantial reductions in the risk of stroke but little or no evidence for benefits on coronary heart disease (CHD) events.1–6 However, the design, numbers of patients recruited, and event rates in individual trials provided inadequate power to evaluate the impact of treatment on CHD events. In only 1 trial, the Hypertension Detection and Follow-up Programme (HDFP),7 was a reduction in CHD events observed in those assigned "special care" compared with those assigned "usual care." The conduct of this particular trial, however, differed from the other early trials in that those in the special care group would have been likely to benefit from more comprehensive intervention on other cardiovascular risk factors.
In the first