This study of a Danish natonwide cohort of patients with uncomplicated hypertension reports that antihypertensive treatment with a β-blocker may be associated with increased risks of perioperative major adverse cardiovascular events and all-cause mortality.
This cohort study evaluates the deintensification of medication used for glucose and blood pressure control in individuals older than 70 years with diabetes mellitus and discusses the possibility for reducing overtreatment.
This randomized clinical trial assesses whether discontinuing antihypertensive treatment improves cognitive, psychological, and general daily functioning in a population of elderly individuals with mild cognitive impairment and without serious cardiovascular disease.
This longitudinal study raises questions regarding the safety of combination antihypertensive therapy regimen in frail elderly patients with low systolic blood pressure.
This meta-analysis determines that vitamin D supplementation does not lower blood pressure in a population of patients using vitamin D or its analogues.
This cohort study finds that low daytime systolic blood pressure was independently associated with a greater progression of cognitive decline in older patients with dementia and mild cognitive impairment among those treated with antihypertensive drugs. See the Invited Commentary by Sabayan and Westendorp.
Tinetti et al determine whether antihypertensive medication use was associated with experiencing a serious fall injury in a nationally representative sample of older adults. See also the invited commentary by Berry and Kiel.
Li and colleagues evaluate associations between use of various classes of antihypertensive medications and risks of invasive ductal and invasive lobular breast cancers among postmenopausal women. Coogan extends the discussion in her Invited Commentary.
It is still debated whether there are differences among the various antihypertensive strategies in heart failure prevention. We performed a network meta-analysis of recent trials in hypertension aimed at investigating this issue.
Randomized, controlled trials published from 1997 through 2009 in peer-reviewed journals indexed in the PubMed and EMBASE databases were selected. Selected trials included patients with hypertension or a high-risk population with a predominance of patients with hypertension.
A total of 223 313 patients were enrolled in the selected studies. Network meta-analysis showed that diuretics (odds ratio [OR], 0.59; 95% credibility interval [CrI], 0.47-0.73), angiotensin-converting enzyme (ACE) inhibitors (OR, 0.71; 95% CrI, 0.59-0.85) and angiotensin II receptor blockers (ARBs) (OR, 0.76; 95% CrI, 0.62-0.90) represented the most efficient classes of drugs to reduce the heart failure onset compared with placebo. On the one hand, a diuretic-based therapy represented the best treatment because it was significantly more efficient than that based on ACE inhibitors (OR, 0.83; 95% CrI, 0.69-0.99) and ARBs (OR, 0.78; 95% CrI, 0.63-0.97). On the other hand, diuretics (OR, 0.71; 95% CrI, 0.60-0.86), ARBs (OR, 0.91; 95% CrI, 0.78-1.07), and ACE inhibitors (OR, 0.86; 95% CrI, 0.75-1.00) were superior to calcium channel blockers, which were among the least effective first-line agents in heart failure prevention, together with β-blockers and α-blockers.
Diuretics represented the most effective class of drugs in preventing heart failure, followed by renin-angiotensin system inhibitors. Thus, our findings support the use of these agents as first-line antihypertensive strategy to prevent heart failure in patients with hypertension at risk to develop heart failure. Calcium channel blockers and β-blockers were found to be less effective in heart failure prevention.