Document Detail


Do ancillary properties of antihypertensive drugs explain the outcome results of recent trials?
MedLine Citation:
PMID:  12243374     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In a quantitative overview of published trials, we investigated whether some pharmacological properties of antihypertensive drugs, besides reduction in blood pressure, explain cardiovascular outcomes in hypertensive or high-risk patients. METHODS: Across trials, using meta-regression, we correlated odds ratios with differences in systolic blood pressure between study groups. We then compared odds ratios of benefit observed in recent trials with those predicted by metaregression on the basis of the differences in systolic pressure between randomised groups. RESULTS: Significant differences in systolic pressure between randomised groups (experimental minus reference) were observed in the ALLHAT (-2/+1), CAPPP(-3/-1) and NORDIL (-3.1/+0.2) trials. Furthermore, the differences in achieved systolic and/or diastolic pressure between study groups were also significant in the hypertension trials which involved untreated control patients, as well as in MIDAS (-3.5/ approximately 0 mm Hg), HOPE (-3.3/-1.0 mm Hg), PART2 (-5/-4 mm Hg), and SCAT (4/-2 mm Hg) (1). The differences between the observed odds ratios and those predicted by the meta-regression between outcome and difference in systolic pressure did not reach statistical significance except for the NORDIL trial, in which the risk of stroke was lower on diltiazem than on the older drugs despite a 3.1 mm Hg higher systolic pressure on the calcium-channel blocker. CONCLUSIONS: The finding that in the reviewed trials blood pressure reduction largely accounted for outcome emphasizes the desirability of blood pressure control. The hypothesis that converting-enzyme inhibitors or alpha-blockers might influence cardiovascular prognosis over and beyond their antihypertensive effect remains unproved.
Authors:
Jan A Staessen; Jiguang Wang
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Journal of nephrology     Volume:  15     ISSN:  1121-8428     ISO Abbreviation:  J. Nephrol.     Publication Date:    2002 Jul-Aug
Date Detail:
Created Date:  2002-09-23     Completed Date:  2003-01-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  422-7     Citation Subset:  IM    
Affiliation:
Study Coordinating Centre, Department of Molecular and Cardiovascular Research, University of Leuven, Belgium. jan.staessen@med.kuleuven.ac.be
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / pharmacology,  therapeutic use*
Blood Pressure Determination
Cardiovascular Diseases / complications,  diagnosis,  drug therapy*,  mortality*
Female
Humans
Hypertension / complications,  diagnosis,  drug therapy*
Linear Models
Male
Odds Ratio
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Sensitivity and Specificity
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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