Standard heart regimens reduce cardiovascular events by similar degree
Reducing blood pressure led to reduced risk for cardiovascular events |
All the commonly used blood-pressure lowering regimens reduce the risk of total major cardiovascular events by a similar degree, an analysis of 29 trials published in The
Lancet has revealed (2003;362:1527).
Investigators from the Blood Pressure Lowering Treatment Trialists’ Collaboration
conducted prospectively designed overviews using data from the trials,
which involved over 160,000 participants and over 700,000 patient-years.
They found that in placebo-controlled trials, the relative risks of total
major cardiovascular events were reduced by regimens based on angiotensin
converting enzyme (ACE) inhibitors or calcium antagonists. Regimens based
on angiotensin-receptor blockers also reduced risk when compared with
control regimens. Larger reductions in blood pressure were associated
with larger reductions in risk.
The investigators did not observe any significant differences in total
major cardiovascular events between regimens based on ACE inhibitors,
calcium antagonists, diuretics or beta-blockers. However, cause-specific
cardiovascular outcomes were affected by the regimen used.
Regimens based on ACE inhibitors, diuretics or beta-blockers were more
effective at preventing heart failure than regimens based on calcium
antagonists. Conversely, for stroke, regimens based on calcium antagonists
had a greater, although non-significant, effect on risk than those based
on diuretics or beta-blockers. There was also a trend towards greater
reductions in stroke with regimens based on any of these three types
of agent than with regimens based on ACE inhibitors.
“
Our results, assessed in the context of other relevant data and treatment
guidelines, should enhance the ability of clinicians and health policy
makers to make evidence-based decisions about the use of the different
blood-pressure-lowering regimens currently available,” the investigators
conclude. |
