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Blood Pressure-Lowering Treatment and the Prevention of Heart Failure: Differences and Similarities of Antihypertensive Drug Classes

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Hypertension and Heart Failure

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

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Abstract

Benefit of blood pressure (BP)-lowering treatment on various outcomes was evaluated by meta-analyses restricted to randomized controlled trials (RCTs) measuring all major outcomes. The question whether BP-lowering and each class of antihypertensive agents prevent “new-onset” heart failure was explored by additional meta-analyses limited to RCTs excluding baseline heart failure from randomization. Thirty-five BP-lowering RCTs measured all outcomes, and heart failure [RR 0.63 (0.52–0.75)] and stroke [RR 0.58 (0.49–0.68)] were the outcomes most effectively prevented. Heart failure and stroke reductions were significantly related to systolic BP, diastolic BP, and pulse pressure reductions. In 18 BP-lowering RCTs excluding baseline heart failure from recruitment, heart failure reduction (“new-onset” heart failure) [RR 0.58 (0.44–0.75)] was very similar to that observed in the entire set of RCTs. In meta-analyses of head-to-head comparisons of different antihypertensive classes, calcium antagonists were inferior in preventing “new-onset” heart failure [RR 1.16 (1.01–1.33)]. However, this inferiority disappeared when meta-analysis was limited to RCTs allowing concomitant use of diuretics, beta-blockers, or renin-angiotensin system blockers, also in the calcium antagonist group [RR 0.96 (0.81–1.12)]. BP-lowering treatment effectively prevents “new-onset” heart failure. It is suggested that BP lowering by calcium antagonists is effective as BP lowering by other drugs in preventing “new-onset” heart failure, unless the trial design creates an unbalance against calcium antagonists.

† Deceased

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Acknowledgments

The data, concepts, and figures reported in this chapter are largely taken from an original article published by the authors in the Journal of Hypertension [3]. Wolters Kluwer Health, Inc., is thanked for permission.

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Authors and Affiliations

  1. Department of Cardiology, Helena Venizelou Hospital, Athens, Greece

    Costas Thomopoulos

  2. Scientific Direction, Istituto Auxologico Italiano IRCCS, Milan, Italy

    Alberto Zanchetti

  3. Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università degli Studi di Milano, Milan, Italy

    Alberto Zanchetti

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  1. Costas Thomopoulos
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Correspondence to Costas Thomopoulos .

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Editors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy Bucharest and Cardiology Department, Emergency Clinical Hospital, Bucharest, Romania

    Maria Dorobantu

  2. University of Milano-Bicocca, Milano, Italy

    Giuseppe Mancia  & Guido Grassi  & 

  3. Department of Pharmacology, Toxicology and Clinical Psychopharmacology Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Victor Voicu

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Thomopoulos, C., Zanchetti, A. (2019). Blood Pressure-Lowering Treatment and the Prevention of Heart Failure: Differences and Similarities of Antihypertensive Drug Classes. In: Dorobantu, M., Mancia, G., Grassi, G., Voicu, V. (eds) Hypertension and Heart Failure. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-93320-7_18

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  • DOI: https://doi.org/10.1007/978-3-319-93320-7_18

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