Page 10 - hypertension_newsletter6

REFLECTIONS
Hypertension
Hypertension Global Newsletter #6 2024

After multivariable adjustment, a 10% increase in SBP TTR
was independently associated with a 7% lower risk of incident
AF (HR 0.93 [95% CI, 0.88–0.97]; P=0.003). In addition, there
Hypertension
was no evidence of effect variation of the associations between
SBP TTR and incident AF by age (<75 versus ≥75 years), sex,
cardiovascular disease history, chronic kidney disease history,
SBP tertiles, AF history, and treatment group.

The authors conclude that maintaining SBP within 110 to 140
WATCH mm Hg over a longer period may be a potential therapeutic
PROF. ALTA SCHUTTE DISCUSS THE target to reduce the risk of atrial fibrillation.
BENEFITS OF MEASURING ‘TIME IN THE
TARGET RANGE’ IN RECENT CLINICAL
TRIALS IN A LECTURE PRESENTED
DURING THE 31ST EUROPEAN CLICK HERE
MEETING ON HYPERTENSION AND FOR THE LINK TO FULL ARTICLE
CARDIOVASCULAR PROTECTION
ORGANISED BY THE EUROPEAN
SOCIETY OF HYPERTENSION.
(13 MIN 23 SEC)

Randomized clinical outcome trials in hypertension.

Mancia G, Kjeldsen SE. Hypertension. 2024 Jan;81(1):17-23.

In this perspective article, the authors provide a historical overview of outcome-based hypertension RCTs. They discuss how
the protective effect of antihypertensive treatment by earlier trials in the 70s led to the design and conduction of many more
trials that allowed the effect of BP reduction on outcomes to be studied in several hundred thousand patients characterised by
widely different demographic and clinical conditions.

The authors summarise some of the key additional protective effects of antihypertensive treatment, including all-cause
mortality, reduction in the development of end-stage kidney disease and related risks in both diabetic and non-diabetic
nephropathy, and protection against ischaemic, thrombotic and embolic, and hemorrhagic strokes. They also review some of
the demographic differences, but also clear benefits of BP-lowering interventions assessed in trials, including different sexes,
ethnicities, and age groups.

Comorbidities are prominent in people with hypertension, and there are many dedicated trials or subanalyses of large trial
subgroups that have shown that antihypertensive treatment is beneficial in these patients. The authors note that there have
been many trials over the past 50 years that have attempted to 1) identify which antihypertensive treatment strategies might
be more effective for achieving BP reduction, 2) determine whether some drugs might have BP-independent protective effects
that could increase the patient’s overall protection at a given on-treatment BP level, and 3) determine which demographic and
clinical subgroups of patients might exhibit the above two advantages. Their commentary is provided in the table below.

While some questions still remain on which treatment strategies are more protective than others, the authors comment that a
few undisputable findings have emerged and made their way into recommendations and guidelines. These include the fact that
the best treatment strategy to reduce and control an elevated BP is to combine drugs with different mechanisms of action (but
not ACEi combined with ARB) or that some antihypertensive drugs may have BP-independent protective properties.

The authors also discuss the evidence for establishing BP thresholds and targets for treatment, along with the trials that have
examined intensive lowering of BP and the lack of outcome trials for resistant hypertension. They also examine some of the
limitations and flaws in research regarding trials in hypertension.

TABLE OF CONTENTS