First-line drugs for hypertension

Wright, James M; Musini, Vijaya M

doi:10.1002/14651858.cd001841.pub2

Cited by 154 publications

(112 citation statements)

References 133 publications

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“…10 The estimated NNS in MARC of 183 (CACS alone) or 159 (CACS combined with CCTA) in order to prevent one cardiovascular event in the next 5 years with statin treatment is low compared to other accepted screening tests, such as mammography to prevent a death from breast cancer in women aged 50-59 years (NNS 2451) or a cardiovascular event in mild-to-moderate hypertension (140-160 mmHg; NNS 279). 30,31 The NNS would have been even lower if we had used the lower 21 instead of the higher 28 NNT estimate derived from the MESA study. 21 Investigating asymptomatic persons with CCT invariably raises issues.…”

Section: Discussionmentioning

confidence: 98%

Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete’s Risk of Cardiovascular Events (MARC) study

Braber

Mosterd

Prakken

et al. 2016

Eur J Prev Cardiolog

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Section: Discussionmentioning

confidence: 98%

Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete’s Risk of Cardiovascular Events (MARC) study

Braber

Mosterd

Prakken

et al. 2016

Eur J Prev Cardiolog

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“…230,234–237 In one of these meta-analyses evaluating different classes of agents used as first-line therapy in subjects with a baseline BP >140/90 mm Hg, thiazide diuretics (RR, 0.63; 95% CI, 0.57–0.71), β-blockers (RR, 0.83; 95% CI, 0.72–0.97), ACEIs (RR, 0.65; 95% CI, 0.52–0.82), and calcium channel blockers (RR, 0.58; 95% CI, 0.41–0.84) each reduced the risk of stroke compared with placebo or no treatment. 236 Compared with thiazides, β-blockers, ACEIs, and ARBs, calcium channel blockers appear to have a slightly greater effect on reducing the risk of stroke, although the effect is not seen for other cardiovascular outcomes and was of small magnitude (8% relative reduction in risk). 235 One meta-analysis found that diuretic therapy was superior to ACEI therapy, 230 and another found that calcium channel blockers were superior to ACEIs.…”

Section: Well-documented and Modifiable Risk Factorsmentioning

confidence: 98%

Guidelines for the Primary Prevention of Stroke

Meschia¹,

Bushnell²,

Boden‐Albala³

et al. 2014

Stroke

1,583

551

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The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

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“…There is an obvious interest in further investigating whether BP lowering by any of the major classes of antihypertensive therapy can be shown to be effective in reducing all or part of cardiovascular outcomes. Several meta-analyses have approached this problem in the past, [16][17][18][19][20][98][99][100][101][102][103][104][105][106] but none of them has been comprehensive of all BP-lowering RCTs from 1966 to the end of 2013 and simultaneously exclusive of RCTs comparing different active regimens (the latter type of trials aim at avoiding, instead of inducing, a between-group BP difference) and of RCTs investigating antihypertensive drugs in the treatment of conditions different from hypertension (such as myocardial infarction and HF). Figure 3A).…”

Section: Effects Of Bp Lowering Produced By Drugs Belonging To Differmentioning

confidence: 99%

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Zanchetti

Thomopoulos

Parati

2015

Circulation Research

141

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Sixty-eight blood pressure (BP)-lowering randomized controlled trials (defined as randomized controlled trials comparing active treatment with placebo, or less active treatment, achieving a BP difference, performed between 1966 and end 2013 in cohorts with ≥40% hypertensive patients, and exclusive of trials in acute myocardial infarction, heart failure, acute stroke, and dialysis) were identified and meta-analyzed grouping the randomized controlled trials on the basis of clinically relevant questions: (1) does BP lowering reduce all types of cardiovascular outcome? (2) Is prevention of all outcomes proportional to the extent of systolic, diastolic, and pulse BP? (3) Have all classes of BP-lowering drugs been shown capable of reducing all types of cardiovascular outcome? (4) Is BP lowering beneficial when intervention is initiated at any grade (or stage) of hypertension? (5) Do BP-lowering randomized controlled trials provide evidence about systolic BP and diastolic BP targets of treatment? (6) Should BP-lowering treatment be preferentially addressed to patients in higher risk categories promising larger absolute treatment benefits? The results of these meta-analyses provide further support to current hypertension treatment guidelines by showing that BP lowering can significantly reduce major cardiovascular outcomes largely independent of the agents used, significant risk reduction is found at all hypertension grades (stages), and when systolic BP is lowered below a cut off of 140 mm Hg with some further reduction limited to stroke at systolic BP values just <130 mm Hg. Absolute risk reduction progressively increases higher is total cardiovascular risk, but this greater benefit is associated with a progressively higher residual risk, ie, higher treatment failures. (Circ Res.

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First-line drugs for hypertension

Cited by 154 publications

References 133 publications

Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete’s Risk of Cardiovascular Events (MARC) study

Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete’s Risk of Cardiovascular Events (MARC) study

Guidelines for the Primary Prevention of Stroke

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

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