Effects of Blood Pressure Lowering Agents on Cardiovascular Outcomes in Weight Excess Patients: A Systematic Review and
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SYSTEMATIC REVIEW
Effects of Blood Pressure Lowering Agents on Cardiovascular Outcomes in Weight Excess Patients: A Systematic Review and Meta‑analysis Emilio Antonio Francischetti1 · Virginia Genelhu de Abreu1 · Luiz Felipe da Silva Figueiredo1 · Rômulo Sperduto Dezonne1 · Evandro Silva Freire Coutinho2
© Springer Nature Switzerland AG 2020
Abstract Background Obesity hypertension is an ongoing pandemic. The first-line medications to treat this condition are still subject to debate. We compared diuretics, calcium-channel blockers (CCB), beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) as an initial antihypertensive therapy for prevention of cardiovascular morbimortality of hypertensive individuals who are overweight or obese. Methods We conducted a search of the literature for randomized clinical trials in which at least 50% of the participants were overweight or obese. The primary outcomes were all-cause mortality, cardiovascular mortality, acute myocardial infarction (MI), heart failure (HF), stroke, or end-stage renal disease. Results Our search yielded 16 randomized studies. Comparisons of two classes of drugs with at least two studies indicated that (1) CCB and ACEI increased the risk of HF [relative risk (RR) = 2.26; 95% confidence interval (CI) 1.16–4.40] and stroke [hazard ratio (HR) = 1.13; 1.00–1.26]), respectively, compared to diuretics; and (2) CCB showed a reduction in stroke (HR = 0.77; 0.66–0.89) and total mortality (HR = 0.94; 0.87–1.01) compared to the BB atenolol. Comparisons of two classes of antihypertensive medications with only one study showed that the risk of MI was higher with ARB valsartan versus CCB (HR = 1.19; 95% CI 1.02–1.38, p = 0.02). In contrast, losartan lowered the risk of a composite cardiovascular outcome compared to atenolol (HR = 0.87; 95% CI 0.77–0.98, p = 0.02). Conclusions In hypertensive subjects with excess weight, diuretics are more effective for preventing HF and stroke than CCB and ACEI, respectively. CCB are a good first-line choice for prevention of cardiovascular disease, except HF.
1 Introduction Obesity is one of the few preventable cardiometabolic risk factors with pandemic prevalence. In 2016, more than 1.9 billion adults were overweight. Of these, over 650 million were obese [1]. In the United States, a matter of concern is the recent increasing prevalence of the most severe groups of obesity [body mass index (BMI) more than 35 kg/m2] [2]. Hypertension is also pandemic, and its prevalence has been increasing. In 2000, 26.4% of the world’s adult population (972 million) had hypertension (defined as 140/90 or higher) * Emilio Antonio Francischetti [email protected] 1
Postgraduate Program on Translational Biomedicine, Grande Rio University, Duque de Caxias, RJ, Brazil
Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
2
[3], whilst in 2010, 31.1% of the world’s adults had hypertension, or 1.39 billion people [4]. It has been suggested, by long-te
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