Blood Pressure-Lowering Treatment and the Prevention of Heart Failure: Differences and Similarities of Antihypertensive
Benefit of blood pressure (BP)-lowering treatment on various outcomes was evaluated by meta-analyses restricted to randomized controlled trials (RCTs) measuring all major outcomes. The question whether BP-lowering and each class of antihypertensive agents
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Costas Thomopoulos and Alberto Zanchetti†
18.1 A ntihypertensive Treatment and Heart Failure: Prevention of Recurrences or Prevention of New-Onset Heart Failure? Moser and Hebert were the first to call attention to the finding that blood pressure (BP)-lowering treatment did not only reduce risk of fatal and nonfatal stroke and fatal and nonfatal coronary heart disease (CHD) events but also risk of heart failure [1]. They reviewed data from 12 placebo (or no treatment)-controlled randomized trials (RCTs) including 13,837 hypertensive patients and calculated heart failure risk was reduced by 51% (risk ratio [RR] and 95% confidence interval [CI] 0.48 [0.38–0.59]). They also remarked that most of the positive RCTs they had considered had used a diuretic as BP-lowering drug [1]. In a very large meta-analysis updated to end 2013 and including 68 RCTs on as many as 245,885 participants, we extended Moser and Herbert’s early analysis and we demonstrated that heart failure risk was significantly reduced by a standardized systolic BP/diastolic BP reduction of 10/5 mmHg and that heart failure reduction was even numerically greater than that of stroke (−43% vs. −38%) and much greater than the albeit significant reductions of CHD events and cardiovascular and all-cause mortality [2]. A more stringent comparison was subsequently done by our group by restricting meta-analyses to only those 35 BP-lowering RCTs (146,810 individuals) measuring all major cause-specific events (stroke, CHD, heart failure, cardiovascular † Deceased C. Thomopoulos (*) Department of Cardiology, Helena Venizelou Hospital, Athens, Greece e-mail: [email protected] A. Zanchetti Scientific Direction, Istituto Auxologico Italiano IRCCS, Milan, Italy Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università degli Studi di Milano, Milan, Italy © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_18
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mortality) [3], and we reported that heart failure and stroke were by far the outcomes most extensively reduced by BP lowering (RR stroke 0.58 [0.49–0.68]; heart failure 0.63 [0.52–0.75]), without a significant difference between the two reductions. We also calculated a meta-regression to compare the relationships between the relative risk reductions of the various outcomes with the extent of BP reduction [3] and found the steepest slopes for the relationships with heart failure and stroke with no significant differences between these slopes (p = 0.69, 0.78, and 0.67 for systolic BP, diastolic BP, and pulse pressure reductions, respectively). On the other hand, the slopes of heart failure reduction were significantly greater than those of all-cause mortality reduction (p = 0.022, 0.024 for systolic BP and pulse pressure reductions), although decreased mortality (both cardiovascular and all-cause) was also a significant effect. In no one of our meta-regression analys
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