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The PREVER Study

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Prehypertension and Cardiometabolic Syndrome

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

The PREVER study addressed two open issues in the management of prehypertension and hypertension. The PREVER-PREVENTION trial evaluated the effectiveness of a low dose of chlorthalidone with amiloride in the prevention of hypertension and target organ damage. The PREVER-TREATMENT trial compared the BP-lowering effect of diuretics and angiotensin receptor blockers and their BP effects on surrogate outcomes. Both were randomized, parallel, double-blind, controlled trials, conducted in parallel in 21 Brazilian academic centers, with 730 and 655 participants, respectively. Participants were eligible if remained with prehypertension or Stage-1 hypertension, respectively, after 3 months of lifestyle intervention. The incidence of hypertension was significantly lower along 18 months of follow-up in participants allocated to diuretics compared to placebo (hazard ratio 0.56, 95% CI 0.38–0.82). Left ventricular mass assessed by ECG indices decreased to a greater extent in participants allocated to diuretic.

In the PREVER-TREATMENT trial, participants randomized to chlorthalidone/amiloride had a more intense lowering of BP along the trial (2.3 mmHg on average of systolic BP, 95% CI: 1.2 to 3.3), despite the higher proportion of participants who had the initial dose doubled and used additional agents to control BP in the losartan arm. The findings of the PREVER-prevention trial underpins the recommendation for drug treatment of individuals with prehypertension who do not respond to recommendations to change their lifestyle. The findings of the PREVER-treatment trial show that the treatment of hypertension should start with effective BP-lowering agents such as diuretics.

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Acknowledgments

Sources of Funding: The Ministry of Health, Division of Science and Technology (DECIT), and Ministry of Science and Technology, Brazilian Innovation Agency (FINEP) (number 01080606/01), National Counsel of Technological and Scientific Development (CNPq), National Institute of Health Technology Assessment (IATS), and Hospital de Clinicas de Porto Alegre (FIPE-GPPG: 08621), RS, Brazil sponsored the PREVER study.

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Authors and Affiliations

  1. Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Sandra Costa Fuchs

  2. Division of Cardiology, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Flávio Danni Fuchs

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  1. Sandra Costa Fuchs
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Editors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Reuven Zimlichman

  2. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Stevo Julius

  3. Emeritus Professor of Medicine, University of Milano-Bicocca, Milan, Italy

    Giuseppe Mancia

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Fuchs, S.C., Fuchs, F.D. (2019). The PREVER Study. In: Zimlichman, R., Julius, S., Mancia, G. (eds) Prehypertension and Cardiometabolic Syndrome. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-75310-2_36

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