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Effects of Blood Pressure Lowering Agents on Cardiovascular Outcomes in Weight Excess Patients: A Systematic Review and Meta-analysis

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Abstract

Background

Obesity hypertension is an ongoing pandemic. The first-line medications to treat this condition are still subject to debate. We compared diuretics, calcium-channel blockers (CCB), beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) as an initial antihypertensive therapy for prevention of cardiovascular morbimortality of hypertensive individuals who are overweight or obese.

Methods

We conducted a search of the literature for randomized clinical trials in which at least 50% of the participants were overweight or obese. The primary outcomes were all-cause mortality, cardiovascular mortality, acute myocardial infarction (MI), heart failure (HF), stroke, or end-stage renal disease.

Results

Our search yielded 16 randomized studies. Comparisons of two classes of drugs with at least two studies indicated that (1) CCB and ACEI increased the risk of HF [relative risk (RR) = 2.26; 95% confidence interval (CI) 1.16–4.40] and stroke [hazard ratio (HR) = 1.13; 1.00–1.26]), respectively, compared to diuretics; and (2) CCB showed a reduction in stroke (HR = 0.77; 0.66–0.89) and total mortality (HR = 0.94; 0.87–1.01) compared to the BB atenolol. Comparisons of two classes of antihypertensive medications with only one study showed that the risk of MI was higher with ARB valsartan versus CCB (HR = 1.19; 95% CI 1.02–1.38, p = 0.02). In contrast, losartan lowered the risk of a composite cardiovascular outcome compared to atenolol (HR = 0.87; 95% CI 0.77–0.98, p = 0.02).

Conclusions

In hypertensive subjects with excess weight, diuretics are more effective for preventing HF and stroke than CCB and ACEI, respectively. CCB are a good first-line choice for prevention of cardiovascular disease, except HF.

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Acknowledgements

We would like to thank Mauricio de Assis Fontes for his helpful assistance in the preparation of this article.

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Authors and Affiliations

  1. Postgraduate Program on Translational Biomedicine, Grande Rio University, Duque de Caxias, RJ, Brazil

    Emilio Antonio Francischetti, Virginia Genelhu de Abreu, Luiz Felipe da Silva Figueiredo & Rômulo Sperduto Dezonne

  2. Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil

    Evandro Silva Freire Coutinho

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  1. Emilio Antonio Francischetti
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  2. Virginia Genelhu de Abreu
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  3. Luiz Felipe da Silva Figueiredo
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Authors contributed equally to the manuscript.

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Correspondence to Emilio Antonio Francischetti.

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Funding

ESFC received grants from (1) Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) (project E-26/202.938/2015; http://www.faperj.br/) and (2) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (process no. 307045/20161; http://www.cnpq.br/). The funders had no direct role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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All authors (EAF, VGA, LFSF, RSD, and ESFC) declare that they have no potential conflicts of interest that might be relevant to the contents of this article.

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Francischetti, E.A., de Abreu, V.G., da Silva Figueiredo, L.F. et al. Effects of Blood Pressure Lowering Agents on Cardiovascular Outcomes in Weight Excess Patients: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs 20, 447–470 (2020). https://doi.org/10.1007/s40256-019-00393-x

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