Key result
BP-lowering treatment reduces new-onset heart failure by ~42% versus placebo or less-active treatment.
Why the study?
Does blood pressure-lowering treatment prevent new-onset heart failure in patients without baseline heart failure?
Meta-Analysis
Does blood pressure-lowering treatment prevent new-onset heart failure in patients without baseline heart failure?
Effect estimate: RR 0.58 (95% CI 0.44-0.75)
Blood pressure-lowering treatment effectively prevents new-onset heart failure, with calcium antagonists showing similar efficacy to other classes when concomitant therapies are balanced.
BP-lowering therapy prevents new-onset HF; confirms benefit in patients without baseline disease and supports preventive use in guidelines.
BACKGROUND AND OBJECTIVES: Relative effectiveness of blood pressure (BP)-lowering treatment on various outcomes was evaluated by meta-analyses restricted to randomized controlled trials (RCTs) measuring all major outcomes, and the question whether BP lowering and each class of antihypertensive agents prevent new-onset heart failure by meta-analyses limited to RCTs excluding baseline heart failure from randomization. METHODS: Source of these meta-analyses are our databases of BP-lowering RCTs vs placebo or less-active treatment, and head-to-head comparisons of different antihypertensive classes. Risk ratios (RRs) and 95% confidence intervals of seven outcomes were calculated by a random-effects model. The relationships of outcome reductions to BP differences were investigated by meta-regressions. RESULTS: First, 35 BP-lowering RCTs measured all outcomes, and heart failure [RR 0.63 (0.52-0.75)] and stroke [RR 0.58 (0.49-0.68)] were the outcomes most effectively prevented. Second, heart failure and stroke reductions were significantly related to SBP, DBP and pulse pressure reductions. Third, in 18 BP-lowering RCTs excluding baseline heart failure from recruitment, heart failure reduction ('new-onset' heart failure) [RR 0.58 (0.44-0.75)] was very similar to that in the entire set of RCTs. Fourth, in meta-analyses of head-to-head comparisons of different antihypertensive classes, calcium antagonists were inferior in preventing 'new-onset' heart failure [RR 1.16 (1.01-1.33)]. However, this inferiority disappeared when meta-analysis was limited to RCTs allowing concomitant use of diuretics, β-blockers or renin-angiotensin system blockers also in the calcium antagonist group [RR 0.96 (0.81-1.12)]. CONCLUSION: BP-lowering treatment effectively prevents 'new onset' heart failure. It is suggested that BP lowering by calcium antagonists is effective as BP lowering by other drugs in preventing 'new-onset' heart failure, unless the trial design creates an unbalance against calcium antagonists.
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Thomopoulos et al. (2016) conducted a meta-analysis in High blood pressure. Blood pressure-lowering treatment vs. Placebo or less-active treatment was evaluated on New-onset heart failure (RR 0.58, 95% CI 0.44-0.75). Blood pressure-lowering treatment effectively prevented new-onset heart failure compared to placebo or less-active treatment (RR 0.58; 95% CI 0.44-0.75).
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