Antihypertensive treatment and development of heart failure in hypertension: a Bayesian network meta-analysis of studies in patients with hypertension and high cardiovascular risk.

Abstract

BACKGROUND:

It is still debated whether there are differences among the various antihypertensive strategies in heart failure prevention. We performed a network meta-analysis of recent trials in hypertension aimed at investigating this issue.

METHODS:

Randomized, controlled trials published from 1997 through 2009 in peer-reviewed journals indexed in the PubMed and EMBASE databases were selected. Selected trials included patients with hypertension or a high-risk population with a predominance of patients with hypertension.

RESULTS:

A total of 223,313 patients were enrolled in the selected studies. Network meta-analysis showed that diuretics (odds ratio [OR], 0.59; 95% credibility interval [CrI], 0.47-0.73), angiotensin-converting enzyme (ACE) inhibitors (OR, 0.71; 95% CrI, 0.59-0.85) and angiotensin II receptor blockers (ARBs) (OR, 0.76; 95% CrI, 0.62-0.90) represented the most efficient classes of drugs to reduce the heart failure onset compared with placebo. On the one hand, a diuretic-based therapy represented the best treatment because it was significantly more efficient than that based on ACE inhibitors (OR, 0.83; 95% CrI, 0.69-0.99) and ARBs (OR, 0.78; 95% CrI, 0.63-0.97). On the other hand, diuretics (OR, 0.71; 95% CrI, 0.60-0.86), ARBs (OR, 0.91; 95% CrI, 0.78-1.07), and ACE inhibitors (OR, 0.86; 95% CrI, 0.75-1.00) were superior to calcium channel blockers, which were among the least effective first-line agents in heart failure prevention, together with β-blockers and α-blockers.

CONCLUSIONS:

Diuretics represented the most effective class of drugs in preventing heart failure, followed by renin-angiotensin system inhibitors. Thus, our findings support the use of these agents as first-line antihypertensive strategy to prevent heart failure in patients with hypertension at risk to develop heart failure. Calcium channel blockers and β-blockers were found to be less effective in heart failure prevention.

• Authors: Sebastiano Sciarretta, Francesca Palano, Giuliano Tocci, Rossella Baldini, Massimo Volpe
• Journal: Archives of internal medicine (Arch Intern Med) Vol. 171 Issue 5 Pg. 384-94 (Mar 14 2011) ISSN: 1538-3679 [Electronic] United States
• PMID: 21059964 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: ©2011 American Medical Association. All rights reserved.

Chemical References

• Adrenergic alpha-Antagonists
• Adrenergic beta-Antagonists
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents
• Calcium Channel Blockers
• Diuretics

Topics

• Adrenergic alpha-Antagonists (therapeutic use)
• Adrenergic beta-Antagonists (therapeutic use)
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Bayes Theorem
• Calcium Channel Blockers (therapeutic use)
• Diuretics (therapeutic use)
• Female
• Heart Failure (etiology, prevention & control)
• Humans
• Hypertension (complications, drug therapy)
• Male
• Randomized Controlled Trials as Topic
• Risk