Key result
Antihypertensive treatments yielded a 4% reduction in all-cause mortality across 18 trials (OR 0.96; 95% CI 0.94-0.99; p=0.005), an effect mainly driven by ASCOT, ADVANCE, and HYVET.
Why the study?
Do antihypertensive treatments reduce all-cause mortality in hypertensive patients?
Meta-Analysis (n=210,000)
Do antihypertensive treatments reduce all-cause mortality in hypertensive patients?
Odds Ratio: 0.96 (95% CI 0.94–0.99)
p-value: p=0.005
The mortality benefit of antihypertensive treatments in recent trials is largely driven by specific trials (ASCOT, ADVANCE, HYVET), suggesting potential specific effects of certain drug classes or regimens.
Supports modest mortality benefit with antihypertensives; extends evidence that gains may be regimen-specific rather than class-wide.
Context: Results of the latest NAVIGATOR trial highlight that antihypertensive treatments may differ in their ability to demonstrate further mortality reduction among patients representative of those treated in the XXIth century. Methods: 18 randomized controlled morbidity-mortality trials gathering 210 000 patients (selection criteria: trials that included >50% of hypertensive patients and main results published between 2000 and 2010) were analyzed. As only 3 strategies evaluated in 3 trials (ASCOT-BPLA, ADVANCE and HYVET) demonstrated significant reductions in all-cause mortality (ACM), a pooled analysis was performed to determine global reduction in ACM. Trials versus placebo and versus active treatment were analyzed separately and jointly. Results: A small but significant 4% reduction in ACM was found in the global analysis of 18 trials (OR = 0.96, 95% CI 0.94–0.99, p = 0.005). When the results of ASCOT, ADVANCE and HYVET (which pooled lead to a 13% reduction, 95% CI 0.81–0.93, p < 0.0001)) were excluded, the treatment effect in the remaining 15 trials became neutral (OR = 0.98, 95% CI 0.95–1.01, p = 0.21) among 176 000 patients. Subgroup analysis according to comparator (active treatment or placebo) were consistent. As these results were not explained by the level of risk of the patients or the duration of the trials, the hypothesis of a specific effect of the treatments and/or dosages used in these trials can not be excluded (perindopril used 3 times, indapamide 2, amlodipine 1).† IDNT, RENAAL, TRANSCEND, PROFESS, ALLHAT, LIFE, ANBP-2, INVEST, VALUE, JIKEI, ONTARGET, ACCOMPLISH, KYOTO, CHARM, NAVIGATOR. *ASCOT-BPLA, ADVANCE, HYVET. Conclusion: Reducing cardiovascular events but also mortality remain key goals in the management of arterial hypertension. Impact of antihypertensive treatments on mortality reduction evaluated among 210 000 nowadays at-risk hypertensive patients appears to be mainly driven by the results of positive arms of ASCOT, ADVANCE and HYVET. As a specific effect of the treatments used can not be eliminated, this should be taken into account when considering the choice of strategies when treating at risk hypertensive patients.
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Mourad et al. (2010) conducted a meta-analysis in Hypertension (n=210,000). Antihypertensive treatments vs. Placebo or active treatment was evaluated on All-cause mortality (OR 0.96, 95% CI 0.94-0.99, p=0.005). Antihypertensive treatments yielded a 4% reduction in all-cause mortality across 18 trials (OR 0.96; 95% CI 0.94-0.99; p=0.005), an effect mainly driven by ASCOT, ADVANCE, and HYVET.
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