CORRESPONDENCE: LETTER TO THE EDITOR
Implications and Controversies of Recent Hypertension Trials
Marc L. Schwartz, MD, FACC*
* Division of Cardiology, Thomas Jefferson University Hospital, 111 South 11th Street, G-4280, Philadelphia, Pennsylvania 19107 (Email: marc.schwartz{at}mail.tju.edu).
Williams has written a comprehensive and thought-provoking review of the recent hypertension literature (1). One of his major contentions is an iteration of the hypothesis that achieving better cardiovascular outcomes depends on more aggressive blood pressure (BP) control and not on the specific choice of antihypertensive agents. In particular, the claim is made that the benefits of ramipril and perindopril evidenced in the HOPE (Heart Outcomes Prevention Evaluation) (2), and EUROPA (EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease) (3) trials, respectively, are due to the lower BP levels achieved by these agents in the treated groups. However, when a similarly decreased level of BP is achieved in the trandolapril-treated group in the PEACE (Prevention of Events with Angiotensin Converting Enzyme inhibition) (4) trial, no cardiovascular outcomes benefit is observed.
Does not this dichotomy denigrate the concept that only the achieved BP level is what matters? Do the results of these three trials suggest that perhaps differences exist among angiotensin-converting enzyme inhibitors beyond their additive BP effects?
 |
References
|
|---|
- Williams B. Recent hypertension trialsimplications and controversies. J Am Coll Cardiol 2005;45:814-827.
- The Heart Outcomes Prevention Evaluation Study Investigators Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients N Engl J Med 2000;342:145-153.[Abstract/Free Full Text]
- EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery diseaserandomized, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003;362:782-788.[CrossRef][ISI][Medline]
- The PEACE Investigators Angiotensin-converting enzyme inhibitors in stable coronary artery disease N Engl J Med 2004;351:2058-2068.[Abstract/Free Full Text]
|
Top
References