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Antihypertensive treatment improved outcomes in non-hypertensive patients with CVD
Thompson A. JAMA. 2011;305:913-922.
Ventura H. JAMA. 2011;305:940-941.
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Rates of all-cause mortality, stroke, congestive HF and composite CVD events were reduced in CVD patients without hypertension who were treated with antihypertensive medication, meta-analysis data suggested.
In the analysis, investigators searched databases for randomized controlled trials that analyzed the use of antihypertensive treatment for the prevention of CVD events in those with systolic BP of less than 140 mm Hg or diastolic BP of less than 90 mm Hg. The final group of studies included in the analysis (n=25) featured 64,162 patients without hypertension.
Researchers found that compared with controls, participants who received antihypertensive medications had pooled RR reductions in stroke (RR=0.77; 95% CI, 0.61-0.98), congestive HF (RR=0.71; 95% CI, 0.65-0.77), MI (RR=0.80; 95% CI, 0.69-0.93), CVD mortality (RR=0.83; 95% CI, 0.69-0.99), composite CVD events (RR=0.85; 95% CI, 0.80-0.90) and all-cause mortality from random-effects models (RR=0.87; 95% CI, 0.80-0.95). This translated to an absolute risk reduction per 1,000 people of –7.7 for stroke, -43.6 for chronic HF events, -13.3 for MI, -27.1 for composite CVD events, -15.4 for CVD mortality and -13.7 for all-cause mortality.
“Our results show that persons with a history of CVD but with BPs in the normal and prehypertensive ranges can obtain significant benefit from antihypertensive treatments,” the researchers wrote. “Additional randomized trial data are necessary to assess these outcomes in patients without CVD clinical recommendations.”
In an accompanying editorial, Hector O. Ventura, MD, with the John Ochsner Heart and Vascular Institute, New Orleans, and Carl J. Lavie, MD, with the University of Queensland School of Medicine, Brisbane, Australia, said this study adds to the understanding of treatment benefits with agents designed to lower BP among patients with CVD.
“The clinical importance of this study is clear: Pharmacological intervention in patients with CVD and BP levels less than 140/90 mm Hg is associated with a decreased risk of CV morbidity and mortality,” they said. “However, this study does not determine whether lowering BP levels is the reason for improved clinical outcomes. These agents may improve clinical outcomes through multiple other mechanisms (eg, hemodynamic effects unrelated to BP, neurohormonal effects and tissue-level effects).”
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