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Prospectively designed overviews of recent trials comparing antihypertensive regimens based on different drug classes

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Abstract

Randomized trials have provided clear evidence of the beneficial effects of many different blood pressure-lowering regimens compared with placebo. The comparative effects of antihypertensive regimens based on different drug classes are less well established. The Blood Pressure Lowering Treatment Trialists’ Collaboration conducted a series of prospectively designed overviews of randomized trials that compared the effects of different drug classes on major cause-specific outcomes. These overviews found no differences between the effects of regimens based on angiotensin converting enzyme inhibitors and those based on diuretics or b-blockers. There was limited evidence of small differences between regimens based on calcium antagonists and those based on diuretics or ß-blockers. The overviews of regimens based on calcium antagonists compared with those based on angiotensin converting enzyme inhibitors recorded too few events to provide reliable findings. Over the next few years, the findings of ongoing trials and future cycles of overview analyses conducted by the Collaboration should substantially add to these data.

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References and Recommended Reading

  1. Collins R, Peto R, MacMahon S, et al.: Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990, 335:827–839.

    Article  PubMed  CAS  Google Scholar 

  2. Collins R, MacMahon S: Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 1994, 50:272–298.

    PubMed  CAS  Google Scholar 

  3. Gueyffier F, Boutitie F, Boissel JP: INDANA: a meta-analysis on individual patient data in hypertension. Protocol and preliminary results. Therapie 1995, 50:353–362.

    PubMed  CAS  Google Scholar 

  4. MacMahon S, Peto R, Cutler J, et al.: Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990, 335:765–774.

    Article  PubMed  CAS  Google Scholar 

  5. Prospective Studies Collaboration: Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995, 346:1647–1653.

    Article  Google Scholar 

  6. Eastern Stroke and Coronary Heart Disease Collaborative Research Group: Blood pressure, cholesterol and stroke in eastern Asia. Lancet 1998, 352:1801–1807.

    Article  Google Scholar 

  7. Psaty B, Smith N, Siscovick D, et al.: Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997, 277:739–745.

    Article  PubMed  CAS  Google Scholar 

  8. The Heart Outcomes Prevention Evaluation Study Investigators: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000, 342:145–153.

    Article  Google Scholar 

  9. Staessen J, Fagard R, Thijs L, et al.: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997, 350:757–764.

    Article  PubMed  CAS  Google Scholar 

  10. Medical Research Council Working Party: MRC trial of treatment of mild hypertension. Principal results. BMJ 1985, 291:97–104.

    Google Scholar 

  11. Medical Research Council Working Party: Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992, 304:405–412.

    Article  Google Scholar 

  12. Wilhelmsen L, Berglund G, Elmfeld D: beta-Blockers versus diuretics in hypertensive men. Main results from the HAPPHY trial. J Hypertens 1987, 5:561–576.

    Article  PubMed  CAS  Google Scholar 

  13. The IPPPSH Collaborative Group: Cardiovascular risk and risk factors in a randomised trial of treatment based on the beta-blocker oxprenolol: the International Prospective Primary Prevention Study in Hypertension (IPPPSH). J Hypertens 1985, 3:379–392.

    Article  Google Scholar 

  14. Neaton JD, Grimm RHJ, Prineas RJ, et al.: Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA 1993, 270:713–724.

    Article  PubMed  CAS  Google Scholar 

  15. The GLANT Study Group: A 12-month comparison of ACE-inhibitor and Ca-antagonist therapy in mild to moderate essential hypertension—The GLANT Study. Hypertens Res 1995, 18:235–244.

    Google Scholar 

  16. Materson B, Reda D, Cushman W: Department of Veteran Affairs single drug therapy of hypertension study. Revised figures and new data. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Am J Hypertens 1995, 8:189–192.

    Article  PubMed  CAS  Google Scholar 

  17. Borhani N, Mercuri M, Borhani P, et al.: Final outcome results of the Multicentre Isradipine Diuretic Atherosclerosis Study (MIDAS). A randomized controlled trial. JAMA 1996, 276:785–791.

    Article  PubMed  CAS  Google Scholar 

  18. World Health Organization-International Society of Hypertension Blood Pressure Lowering Treatment Trialists’ Collaboration: Protocol for prospective collaborative overviews of major randomized trials of blood-pressure lowering treatments. J Hypertens 1998, 16:127–137. Protocol for the World Health Organization-International Society of Hypertension Blood Pressure Lowering Treatment Trialists’ Collaboration. This report details a priori the criteria for trial inclusion, the hypotheses for investigation, the outcomes to be studied, and the methods to be used.

    Google Scholar 

  19. Collins R, MacMahon S: Reliable assessment of the effects of treatment on mortality and major morbidity, I: clinical trials. Lancet 2001, 357:373–380. A clear explanation of the strengths and weaknesses of clinical trials and overviews, written to aid the practicing clinician.

    Article  PubMed  CAS  Google Scholar 

  20. Blood Pressure Lowering Treatment Trialists’ Collaboration: Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet 2000, 356:1955–1964. Full results of the first cycle of analyses of the Blood Pressure Lowering Treatment Trialists’ Collaboration. Includes overviews of trials comparing blood pressure-lowering regimens based on ACE inhibitors and calcium antagonists with placebo, trials comparing more intensive and less intensive blood pressure-lowering strategies, and trials comparing blood pressure-lowering regimens based on different drug classes.

    Article  Google Scholar 

  21. Hansson L, Lindholm L, 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.

    Article  PubMed  CAS  Google Scholar 

  22. Hansson L, Lindholm L, Ekbom T, et al.: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity in the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999, 354:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  23. UK Prospective Diabetes Study Group: Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes. BMJ 1998, 317:713–720.

    Google Scholar 

  24. Brown M, Palmer C, 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. Lancet 2000, 356:366–372.

    Article  PubMed  CAS  Google Scholar 

  25. National Intervention Cooperative Study in Elderly Hypertensives Study Group: Randomized double-blind comparison of a calcium antagonist and a diuretic in elderly hypertensives. Hypertension 1999, 34:1129–1133.

    Google Scholar 

  26. Hansson L, Hedner T, Lund-Johansen P, et al.: Randomised trial of effects of calcium antagonists compared with diuretics and ß-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000, 356:359–365.

    Article  PubMed  CAS  Google Scholar 

  27. Agabiti-Rosei E, Dal Palu C, Leonetti G, et al.: Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. J Hypertens 1997, 15:1337–1344.

    Article  Google Scholar 

  28. Estacio R, Jeffers B, Hiatt W, 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.

    Article  PubMed  CAS  Google Scholar 

  29. Cook NR, Cohen J, Hebert P, et al.: Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med 1995, 155:701–709.

    Article  PubMed  CAS  Google Scholar 

  30. Pocock S, White I: Trials stopped early: too good to be true? Lancet 1999, 353:943–944.

    Article  PubMed  CAS  Google Scholar 

  31. 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.

    Article  PubMed  CAS  Google Scholar 

  32. Cashin-Hemphill L, Holmvang G, Chan R, et al.: Angiotensin converting enzyme inhibition as antiatherosclerotic therapy: no answer yet. Am J Cardiol 1999, 83:43–47.

    Article  PubMed  CAS  Google Scholar 

  33. Teo K, Burton J, Buller C, 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.

    PubMed  CAS  Google Scholar 

  34. Pitt B, Byington R, Furberg C, et al.: Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000, 102:1503–1510.

    PubMed  CAS  Google Scholar 

  35. Collins R, Peto R, Gray R, et al.: Large-scale randomized evidence: trials and overviews. In Oxford Textbook of Medicine, edn 3. Edited by Weatherall D, Ledingham J, Warrell D. Oxford: Oxford University Press; 1996:21–32.

    Google Scholar 

  36. Psaty B, Heckbert S, Koepsell T, et al.: The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA 1995, 274:620–625.

    Article  PubMed  CAS  Google Scholar 

  37. Klungel O, Heckbert S, Longstreth W, et al.: Antihypertensive drug therapies and the risk of ischemic stroke. Arch Intern Med 2001, 161:37–42.

    Article  PubMed  CAS  Google Scholar 

  38. Pahor M, Guralnik J, Corti M, et al.: Long-term survival and use of antihypertensive medications in older persons. J Am Geriatr Soc 1995, 43:1–7.

    Google Scholar 

  39. Michels K, Rosner B, Manson J, et al.: Prospective study of calcium channel blocker use, cardiovascular disease, and total mortality among hypertensive women: The Nurses’ Health Study. Circulation 1998, 97:1540–1548.

    PubMed  CAS  Google Scholar 

  40. Abascal V, Larson M, Evans J, et al.: Calcium antagonists and mortality risk in men and women with hypertension in the Framingham Heart Study. Arch Intern Med 1998, 158:1882–1886.

    Article  PubMed  CAS  Google Scholar 

  41. MacMahon S, Collins R: Reliable assessment of the effects of treatment on mortality and major morbidity, II: observational studies. Lancet 2001, 357:455–462. A clear explanation of the strengths and weaknesses of observational studies, written to aid the practicing clinician.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Institute for International Health, University of Sydney, PO Box 576, NSW 2042, Newtown, Sydney, Australia

    Neil Chapman MRCP & Bruce Neal MRCP, PhD

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  1. Neil Chapman MRCP
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  2. Bruce Neal MRCP, PhD
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Chapman, N., Neal, B. Prospectively designed overviews of recent trials comparing antihypertensive regimens based on different drug classes. Current Science Inc 3, 340–349 (2001). https://doi.org/10.1007/s11906-001-0097-4

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  • DOI: https://doi.org/10.1007/s11906-001-0097-4

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