June 9, 2008Journal of Hypertension
Development of heart failure in recent hypertension trials
Key result
Hypertension in recent clinical trials was associated with a heart failure incidence comparable to stroke (8.5 vs 9.1 events per 1000 patients; P=NS), with higher risk in older and diabetic patients.
Why the study?
What is the incidence of heart failure compared to coronary heart disease and stroke in recent hypertension trials?
Population
193,424 patients with hypertension or at 'high' cardiovascular risk with a predominant presence of…
Design
Systematic_review
Authors
Discussion
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Implication
Elevates heart failure prevention to parity with stroke in hypertension management; confirms comparable incidence from recent trial data.
Key Points
- To evaluate the incidence of heart failure relative to coronary heart disease and stroke, and to assess risk predictors among participants in recent clinical trials for hypertension.
- Conducted a systematic review of 23 trials published between 1997 and 2007, encompassing 193,424 patients with hypertension or high cardiovascular risk.
- Analyzed the distribution and rates of major cardiovascular events, specifically comparing heart failure, coronary heart disease, and stroke incidence.
- Among 24,837 major cardiovascular events recorded, heart failure accounted for 28.9% (7,171 cases), stroke for 30.0% (7,443 cases), and coronary heart disease for 41.1% (10,223 cases).
- Heart failure event rates (8.5 per 1,000 patients) were not significantly different from stroke rates (9.1 per 1,000 patients; P = NS).
- Heart failure risk was heightened in diabetic versus nondiabetic patients (OR 4.91, 95% CI 4.40–5.43; P < 0.0001), older individuals (>65 years; OR 3.08, 95% CI 2.88–3.31; P < 0.0001), Black individuals (OR 1.90, 95% CI 1.76–2.06; P < 0.0001), and very high-risk patients (OR 1.29, 95% CI 1.23–1.36; P < 0.0001).
Study Design
Type
Systematic Review (n=193,424)
Structured PICO
What is the incidence of heart failure compared to coronary heart disease and stroke in recent hypertension trials?
P
Population
193,424 patients with hypertension or at 'high' cardiovascular risk with a predominant presence of hypertensive patients from 23 trials concluded between 1997 and 2007.
I
Intervention
Antihypertensive therapy (as evaluated in the included trials)
O
Outcome
Incidence of major cardiovascular events, including heart failure, coronary heart disease and strokehard clinical
Main Result
Absolute Event Rate: 8.5% vs 9.1%
p-value: p=NS
Heart failure development remains a major burden in hypertensive patients, occurring at rates comparable to stroke, particularly in older, black, diabetic, and very high-risk individuals.
Cite This Study
Tocci et al. (2008) conducted a systematic review in Hypertension or high cardiovascular risk (n=193,424). Hypertension in recent clinical trials was associated with a heart failure incidence comparable to stroke (8.5 vs 9.1 events per 1000 patients; P=NS), with higher risk in older and diabetic patients.