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Effects of anti-hypertensive treatment on major cardiovascular events in populations within prehypertensive levels: a systematic review and meta-analysis

Journal of Human Hypertension volume 32, pages 94–104 (2018)Cite this article

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Abstract

Uncertainties still remain in terms of the efficacy of anti-hypertensive treatment on the risk of major cardiovascular (CV) events within prehypertensive levels. This review aims to assess the efficacy and safety of anti-hypertensives on the CV risks in populations within prehypertensive levels. Randomized controlled trials (RCTs) concerning active treatment vs placebo in populations within prehypertensive levels were identified through electronic database and manual search. Outcomes included the first co-primary outcomes, stroke, heart failure (HF), myocardial infarction (MI), all-cause mortality, and cardiovascular mortality. The first co-primary outcomes were defined as composite cardiovascular disease (CVD) events in the included studies. A total of 29 RCTs involving 127,641 participants were identified. Pooled analysis showed active treatment was associated with a significant 7% reduction in risk of the first co-primary outcomes, 14% in stroke, and 10% in HF as compared to placebo (0.86, 0.77–0.96; 0.93, 0.89–0.98; and 0.90, 0.83–0.97). However, there were no significant reductions in risk of MI, all-cause mortality, and cardiovascular mortality. A significant reduction in risk of the first co-primary outcomes was observed in subpopulations with systolic blood pressure (SBP) 130–139 mmHg (0.94, 0.89–0.99) or prior CVDs (0.88, 0.82–0.94). Meta-regression analyses showed no significant relative risk reductions proportional to the magnitude of the mean baseline BP, mean on-treatment BP, the mean absolute change in BP, the proportion of patients with hypertension, and mean age. In summary, anti-hypertensive treatment has beneficial cardiovascular effects in populations within prehypertensive levels, especially in subpopulations with SBP 130–139 mmHg or prior CVDs.

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Author notes

  1. Zhongqiu Hong and Tao Wu authors contributed equally to this work.

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Zhongqiu Hong & Dongmei Jin

  2. Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Tao Wu, Shuxian Zhou, Boshui Huang, Jingfeng Wang & Dengfeng Geng

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Electronic supplementary material

Supplementary Information

Baseline characteristics of randomized controlled trials included in the systematic review

Risk of bias for the included studies

Adverse events occuring in anti-hypertensive treatment group versus placebo

Flowchart of process for selection of articles in meta-analysis

Funnel plots illustrating meta-analysis of the first coprimary outcomes

41371_2017_26_MOESM7_ESM.pdf

Subgroup analyses of the effectiveness of anti-hypertensive treatment on the first coprimary outcomes (a), stroke (b), heart failure (c), myocardial infarction (d), all-cause mortality (e) or cardiova

41371_2017_26_MOESM8_ESM.pdf

Subgroup analyses of the effectiveness of anti-hypertensive treatment on the first coprimary outcomes (a), stroke (b), heart failure (c), myocardial infarction (d), all-cause mortality (e) and cardiov

41371_2017_26_MOESM9_ESM.pdf

Subgroup analyses of the effectiveness of anti-hypertensive treatment on the first coprimary outcomes (a), stroke (b), heart failure (c), myocardial infarction (d), all-cause mortality (e) and cardiov

41371_2017_26_MOESM10_ESM.pdf

Sensitivity analysis of HBP<50% in term of the effectiveness of anti-hypertensive treatment on the first coprimary outcomes (A), stroke (B), heart failure (C), myocardial infarction (D), all-cause mor

41371_2017_26_MOESM11_ESM.pdf

Meta-regression analysis of the association between the first co-primary outcomes and mean baseline SBP (A), mean baseline DBP (B), mean final SBP (C), mean final DBP (D) or HBP% (E)

41371_2017_26_MOESM12_ESM.pdf

Adverse events occurring during anti-hypertensive treatment group versus placebo lead to discontinuation of treatment (A), hyperkalemia (B) or hypotension (C). Cl indicates confidence interval

List of generic name of anti-hypertensive drugs avaiable in the United States

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Hong, Z., Wu, T., Zhou, S. et al. Effects of anti-hypertensive treatment on major cardiovascular events in populations within prehypertensive levels: a systematic review and meta-analysis. J Hum Hypertens 32, 94–104 (2018). https://doi.org/10.1038/s41371-017-0026-x

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