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Antihypertensive therapies lowered risk for HF in patients with hypertension
Frankenstein L. Arch Intern Med. 2011;171:394-395.
Sciarretta S. Arch Intern Med. 2011;171:384-394.
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Patients with hypertension at risk for HF who were treated with diuretics, ACE inhibitors and angiotensin II receptor antagonists compared with placebo had the least likelihood of developing HF, according to new Bayesian network meta-analysis data. Of these, however, diuretics were found to be the most efficient treatment.
To determine the differences of antihypertensive strategies in HF prevention, investigators analyzed randomized controlled trials published between 1997 and 2009 in peer-reviewed journals. The final selection included trials with patients who had hypertension (n=186,378) or who were among a high-risk population with a prevalence of hypertension (n=36,935).
The researchers’ analysis revealed that the most efficient class of drugs to reduce HF compared with placebo was diuretics (OR=0.6; 95% credibility interval [CrI], 0.47-0.73) followed by ACE inhibitors (OR=0.72; 95% CrI, 0.59-0.84) and angiotensin II receptor blockers (OR=0.76; 95% CrI, 0.62-0.9). All three of these therapies were noticeably superior in HF prevention to calcium-channel blockers (OR=0.84; 95% CrI, 0.68-0.99), beta-blockers (OR=0.88; 95% CrI, 0.64-1.13) and alpha-blockers (OR=1.22; 95% CrI, 0.86-1.7), which were the least effective therapies analyzed.
“Our findings support the use of [diuretics and renin-angiotensin system inhibitors] as first-line antihypertensive strategy to prevent HF in patients with hypertension at risk to develop HF,” the researchers concluded.
In an accompanying editorial, Lutz Frankenstein, MD,with the University of Heidelberg in Germany, said before physicians abandon beta-blockers for diuretics in this population, they “should remember that, especially in meta-analyses, the choice of subgroup and, most important, the choice of endpoint will influence our results. … We should therefore concentrate once again on the true center of medical attention — our patient — and we should weigh our choice of first-line treatment against comorbidities, coexisting treatment and personal preferences regarding risk and quality of life.”
Disclosure: Dr. Frankenstein reported no relevant financial disclosures.
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