CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 1st, 2011

CV Patients Without Hypertension Benefit From Antihypertensive Therapy

A new study suggests that patients with CV disease who do not have hypertension may nevertheless benefit from antihypertensive therapy. In a study published in JAMA, Angela Thompson and colleagues performed a meta-analysis of 25 trials including 64,162 patients with CV disease or a risk factor equivalent and without hypertension. Compared to controls, patients who received antihypertensive therapy had

  • a 23% reduction in risk of stroke,
  • a 29% reduction in risk of CHF events,
  • a 15% reduction in risk of a combination of CVD events,
  • and a 13% reduction in risk of all-cause mortality.

In an accompanying editorial, Hector Ventura and Carl Lavie write that “the clinical importance of this study is clear: pharmacological intervention in patients with CVD and blood pressure levels less than 140/90 mm Hg is associated with a decreased risk of cardiovascular morbidity and mortality.” However, they point out that since “many patients could potentially begin taking medications at young ages and for many years to prevent cardiovascular events, even modest costs and adverse effects need to be considered.”

 

Categories: Prevention
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2 Responses to “CV Patients Without Hypertension Benefit From Antihypertensive Therapy”

  1. Susan Cheng, MD says:
    March 2, 2011 at 12:29 pm

    I think the editorial is right on with respect to 2 main points. First, it’s hard to tease out what actions of the anti-hypertensives the benefit is coming from (esp. beta-blockers and ACE inhibitors). Second, the effect in persons without CVD is still completely unclear. As the study authors themselves say: “We identified only 2 studies of antihypertensive treatment conducted in populations with blood pressures less than 140/90 mm Hg and without a history of CVD or diabetes. The primary objective of both trials was to examine the prevention of hypertension in persons with blood pressure in the prehypertensive range, but CVD events were also examined. Although both studies were small and had relatively few events, there was an indication of possible benefit overall.” It’s an intriguing hypothesis, but future studies will need to account for potential adverse effects of overly aggressive therapies in older age groups.

  2. John Ryan, MD says:
    March 3, 2011 at 5:41 pm

    There are some interesting aspects that crop up here as well.
    Take for example, three of the studies included for analysis- SOLVD studied patients with EF <35%, AIRE was a post-MI population and ABCD was diabetics. They are very different populations (as well as an unhealthy population) and even with normal BP should likely be on BB or ACEi anyway.
    Secondly, of the 25 studies included for meta-analysis, only three of them were trials with diuretics, which some argue is first line therapy.
    Do these points change how one sees the trial or as Susan suggested does it simply guide us towards needing to do further studies? I think likely the latter.