Blood pressure-independent impact of antihypertensive agents on cardiovascular and renal disease
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Reduction of elevated blood pressure clearly protects against target organ damage, but the different targets do not necessarily benefit to the same degree. There is considerable debate over whether or not there is a drug-specific benefit above and beyond that conferred by blood pressure reduction alone. We performed a Medline search to identify recent randomized clinical trials including 300 or more patients who were followed for at least 2 years. We critically reviewed these papers to find like trials for comparisons. There was too much dissimilarity to perform a meaningful meta-analysis. We found that the literature does not support a definitive conclusion either in favor of or against an overall drug-specific protective effect. However, by grouping like trials, it is possible to support an additional protective effect by angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on reducing the rate of decline in renal function and in reducing proteinuria.
- Rosei EA, Dal Palu C, Leonetti G, et al.: Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. VHAS Investigators. J Hypertens 1997, 15:1337–1344. CrossRef
- Hansson L, Hedner T, Lund-Johansen P, et al.: Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000, 356:359–365. CrossRef
- Brown MJ, Palmer CR, Castaigne A, et al.: Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 2000, 356:366–372. CrossRef
- Estacio RO, Jeffers BW, Hiatt WR, et al.: The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998, 338:645–652. CrossRef
- Estacio RO, Jeffers BW, Gifford N, et al.: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 2000, 23(Suppl2):B54-B64.
- Randomized double-blind comparison of a calcium antagonist and a diuretic in elderly hypertensives. National Intervention Cooperative Study in Elderly Hypertensives Study Group. Hypertension 1999, 34:1129–1133.
- Hansson L, Lindholm LH, Ekbom T, et al.: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999, 354:1751–1756. CrossRef
- Staessen JA, Fagard R, Thijs L, et al.: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997, 350:757–764. CrossRef
- Tuomilehto J, Rastenyte D, Birkenhager WH, et al.: Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999, 340:677–684. CrossRef
- Dahlof B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:995–1003. Losartan, an ARB, reduced combined cardiovascular endpoints (mainly strokes) when compared with atenolol in an elderly, overweight cohort of patients who had left ventricular hypertrophy. CrossRef
- Lindholm LH, Ibsen H, Dahlof B, et al.: Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002, 359:1004–1010. This substudy of Dahlof et al. [10•] provides evidence of the effectiveness in diabetic patients. CrossRef
- Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153. CrossRef
- Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet 2000, 355:253–259.
- MacMahon S, Sharpe N, Gamble G, et al.: Randomized, placebo-controlled trial of the angiotensin-converting enzyme inhibitor, ramipril, in patients with coronary or other occlusive arterial disease. PART-2 Collaborative Research Group. Prevention of Atherosclerosis with Ramipril. J Am Coll Cardiol 2000, 36:438–443. CrossRef
- Teo KK, Burton JR, Buller CE, et al.: Long-term effects of cholesterol lowering and angiotensin-converting enzyme inhibition on coronary atherosclerosis: The Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT). Circulation 2000, 102:1748–1754.
- Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001, 358:1033–1041.
- Svensson P, de Faire U, Sleight P, et al.: Comparative effects of ramipril on ambulatory and office blood pressures: a HOPE Substudy. Hypertension 2001, 38:E28-E32.
- Hansson L, Lindholm LH, Niskanen L, et al.: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999, 353:611–616. CrossRef
- Tatti P, Pahor M, Byington RP, et al.: Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 1998, 21:597–603. CrossRef
- Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998, 317:713–720.
- Agodoa LY, Appel L, Bakris GL, et al.: Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 2001, 285:2719–2728. CrossRef
- Parving HH, Lehnert H, Brochner-Mortensen J, et al.: The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001, 345:870–878. CrossRef
- Lewis EJ, Hunsicker LG, Clarke WR, et al.: Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001, 345:851–860. Evidence of renoprotection in diabetic patients by irbesartan compared with amlodipine and placebo. Patients had heavy proteinuria. CrossRef
- Brenner BM, Cooper ME, de Zeeuw D, et al.: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001, 345:861–869. Evidence of renoprotection in diabetic patients with proteinuria by losartan compared with placebo. CrossRef
- Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Lancet 1997, 349:1857–1863.
- Maschio G, Alberti D, Janin G, et al.: Effect of the angiotensinconverting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med 1996, 334:939–945. CrossRef
- Blood pressure-independent impact of antihypertensive agents on cardiovascular and renal disease
Current Hypertension Reports
Volume 4, Issue 6 , pp 445-452
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