Do pleiotropic effects of antihypertensive medications exist or is it all about the blood pressure?

Are There Pleiotropic Effects of Antihypertensive Medications or Is It All About the Blood Pressure in the Patient With Diabetes and Hypertension?

“…The pathophysiologic effects of angiotensin II (Ang II), the main effector of the RAS, which potentially lead to CV disease, include vasoconstriction, thrombogenicity, increased production of reactive oxygen species (ROS), vascular smooth muscle growth, myocyte hypertrophy, fibrosis, and maladaptive remodeling of tissues. Moreover, RAS activation serves as the starting point for the release and increased activity of a number of hormonal mediators, inflammatory substances, and cytokines 2 . Primary RAS activation will also trigger formation of a number of secondary messengers and/or activate pathways, which expand on its untoward vascular/tissue effects.…”

“…For a drug to qualify as “going beyond the numbers,” supporting clinical trial evidence can present in any of three possible ways: first, a drug’s effectiveness in reducing CV outcomes must be in excess of (discordant) what might be expected from the BP reduction alone; second, evidence supporting this concept can be obtained (but less reliably so) from clinical trials where BP reduction was superior in one treatment arm and the alternative treatment limb was observed to have better outcomes; and third, from clinical trials where BP reduction was inferior with one treatment and outcomes were equivalent to what was seen with the alternative and superior BP‐lowering treatment limb 2,3 …”

“…In addition to the current debate as to the optimum blood pressure (BP) for preventing cardiovascular (CV) events in the patient with diabetes and hypertension, 1 another area of some dispute is whether certain antihypertensive medications provide a CV and/or renal benefit free of their BP‐lowering effects, a seeming pleiotropic effect. 1 Pleiotropic effects are actions of a drug other than those for which the agent was specifically intended and may be variably related to the primary mechanism of drug action 2,3 …”

Antihypertensive Pharmacotherapy: Adverse Effects of Medications Promote Nonadherence

“…Current hypertension guidelines recommend that multiple medications should be utilized to ensure that patients’ blood pressure is at goal levels 1,2 . Some meta‐analyses have demonstrated that there is not much difference in final blood pressure levels achieved in patients regardless of the agent used, while other studies suggest so‐called pleiotropic effects of different drug classes 3 . Practitioners generally choose antihypertension medications based on results from clinical trials and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommendations and not on whether patients can tolerate the medications.…”