Jay N. Cohn, MD
In patients with a history of cardiovascular disease (CVD) who do not have hypertension, does antihypertensive treatment reduce risk for CVD events and mortality?
Included studies compared antihypertensive treatment with placebo in adults ≥ 18 years of age, who had CVD or CVD equivalents (e.g., diabetes) and blood pressure (BP) < 140 mm Hg systolic or < 90 mm Hg diastolic or a history of hypertension. Outcomes were stroke, myocardial infarction (MI), congestive heart failure (CHF) events, composite CVD events (defined by each study), CVD mortality, and all-cause mortality.
MEDLINE (1950 to Jan 2011), EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Clinical Trials, and reference lists were searched for randomized controlled trials (RCTs). 25 RCTs (n = 64 162, mean age 55 to 68 y, 76% men) met the selection criteria. Mean duration of follow-up ranged from 1.5 to 63 months. Antihypertensive agents assessed were angiotensin-converting enzyme (ACE) inhibitors alone (11 RCTs), β-blockers (7 RCTs), angiotensin-receptor blockers (2 RCTs), ACE inhibitors plus diuretics (2 RCTs), calcium-channel blockers (CCBs) (1 RCT), CCBs or ACE inhibitors (1 RCT), and diuretics alone (1 RCT).
Meta-analysis showed that antihypertensive treatment reduced stroke, MI, CHF, composite CVD outcomes, cardiovascular mortality, and all-cause mortality compared with placebo (Table).
In patients with a history of cardiovascular disease but without hypertension, antihypertensive treatment reduces CVD events and mortality.
Antihypertensive treatment vs placebo in adults with cardiovascular disease (CVD) or CVD equivalents but without hypertension*
*Abbreviations defined in Glossary. RRR and CI calculated from placebo event rates and relative risks in article. NNT and CI calculated from absolute risk reduction.
†Corrected data provided by author.
Cohn JN. Review: Antihypertensive treatment prevents cardiovascular events and mortality in cardiovascular disease without hypertension. Ann Intern Med. ;154:JC6–6. doi: 10.7326/0003-4819-154-12-201106210-02006
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Published: Ann Intern Med. 2011;154(12):JC6-6.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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