More Confusing Messages From the Hypertension Treatment Trials

More Confusing Messages From the Hypertension Treatment Trials

Marvin Moser, MD Editor in Chief

Over the past 5 years, numerous hypertension treatment trials have been completed and reported.1-8 A majority of these trials were initiated to distinguish one therapy from another in reducing cardiovascular (CV) events. Some were blinded and appropriately randomized prospective trials; others were unblinded or prospective cohort studies. Various populations have been studied, and results have differed. Statistical manipulations have often been carried out to prove a point if trial results were different than the investigators had anticipated. An ongoing question remains:

“What really matters in determining therapy?” Is it the lowering of blood pressure (BP) that reduces CV events, or does the use of specific medications account for differing results? A meta-analysis of the clinical trials has determined that it is the degree of BP lowering that makes the major difference in outcome, and not specific medical therapy.9 Many individual trials appear to confirm this conclusion. For example, the Verapamil in Hypertension Atherosclerosis Study (VHAS)10 reported no difference in outcome between a diuretic and verapamil.

The Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE)8 study reported no differences between a verapamil-based treatment and usual care, i.e., a diuretic plus a blocker and other drugs, and the United Kingdom Prospective Diabetes Study (UKPDS)11 in type 2 diabetics reported no difference in outcome between a -blocker-based and an angiotensin-converting enzyme inhibitor (ACEI)-based treatment program if BPs were lowered to an equivalent degree.

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