Similar efficacy and safety for all antihypertensives
All antihypertensives have similar long-term efficacy
and safety, the results of a review show. Any differences in outcome can
largely be accounted for by differences in the reduction of blood pressure
control.
Belgian researchers conducted a meta-analysis of
27 trials involving 136,124 patients to assess the efficacy of antihypertensive
drugs. They included outcome trials for old antihypertensives, such as
diuretics and beta-blockers, and newer agents, such as calcium channel
blockers, angiotensin converting enzyme (ACE) inhibitors and alpha-blockers.
The main finding was that all antihypertensives
had similar efficacy and that the results of the trials could be explained
by blood pressure differences between randomised groups.
"Our results show the desirability of lowering blood
pressure as much as possible to achieve the greatest reduction in cardiovascular
complications," they say. The extent to which blood pressure should be
lowered was not studied.
Compared with older drugs, calcium channel blockers
and ACE inhibitors gave the same overall risk reduction in cardiovascular
complications. Calcium channel blockers gave a greater reduction in risk
of stroke but a smaller reduction in risk of myocardial infarction. However,
this resulted in a largely similar overall cardiovascular benefit as the
older drugs.
The review found no evidence to support suggestions
that ACE inhibitors offer benefits beyond their effects on lowering blood
pressure. The researchers suggest that reduction in blood pressure could
have accounted for most, if not all, of the benefits seen for ACE inhibitors
in outcome trials. Equally, they found no additional benefits for alpha-blockers
beyond their antihypertensive effect.
The study is published in The Lancet 2001;358:1305.
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