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Recent hypertension trials

Implications and controversies

Department of Cardiovascular Sciences, University of Leicester School of Medicine, Leicester, United Kingdom

View larger version (51K): [in a new window]   Figure 1 Effect of angiotensin-converting enzyme inhibitors (ACEi) and calcium channel blockers (CCBs) versus placebo and "more versus less" blood pressure (BP) lowering on cause-specific cardiovascular outcomes. The overall mean BP difference between treatments is shown. Negative values mean lower blood pressure values in the "first listed." CI = confidence interval. Reproduced from the Blood Pressure Lowering Treatment Trialists' Collaboration (2), with permission.

View larger version (47K): [in a new window]   Figure 2 Comparison of blood pressure (BP)-lowering regimens based on different drug classes. Mean blood pressure differences between the first and second treatment regimens are shown. Negative blood pressure values indicate lower pressures with the first treatment listed. ACEi = angiotensin-converting enzyme inhibitor; CCB = calcium channel blocker; CI = confidence interval; D/ßB = diuretic- and/or beta-blocker–based regimens. Reproduced from the Blood Pressure Lowering Treatment Trialists' Collaboration (2), with permission.

View larger version (37K): [in a new window]   Figure 3 Effect of blood pressure lowering in different studies comparing calcium (Ca) channel blocker-based treatment regimens (top panel) or angiotensin-converting enzyme (ACE) inhibitor–based regimens (bottom panel) versus thiazide (Th/Thi/Thiaz.) and/or beta-blocker (BB)–based regimens on cardiovascular outcomes and all-cause mortality. CI = confidence interval; RR = risk ratio. Reproduced from the National Institute of Clinical Excellence Clinical Guideline 18 (4), with permission.

View larger version (26K): [in a new window]   Figure 4 Age-specific hazard ratios for specified differences in usual systolic (A) and diastolic (B) blood pressures. Impact on stroke, ischemic heart disease (IHD), and other vascular events. Data from 61 prospective observational studies of blood pressure and mortality in one million adults with no vascular disease at baseline. CI = confidence interval. Reproduced from the Prospective Studies Collaboration (34), with permission.

View larger version (17K): [in a new window]   Figure 5 Odds ratios for the primary end point (composite of cardiac end points), major cause-specific outcomes, and total mortality during the first three months of the VALUE trial after patients had been randomized to either valsartan or amlodipine monotherapy. Change in blood pressure (BP) at three months refers to the lower mean blood pressures in patients randomized to amlodipine. Data are expressed as the odds ratios ± 95% confidence intervals (CI). Figure is adapted from data extracted from Julius et al. (9).