Early antihypertensive treatment increases survival benefit
MedWire News: Results of a large meta-analysis indicate that cardiovascular disease patients who start antihypertensive treatment approximately 30 months before other patients with the same condition may have reduced mortality in the long term.
The authors of the study, which is published in the journal Hypertension, say they are unsure why early treatment decreases mortality risk, but suggest that early initiation of therapy may lead to "prevention or regression of pathological and functional changes caused by hypertension."
William Kostis (Massachusetts General Hospital, Boston, USA) and colleagues conducted an 18-trial meta-analysis involving 132,854 patients with hypertension, myocardial infarction (MI), or left ventricular systolic dysfunction (LVSD).
All trials assessed were conducted in two phases, with an initial phase lasting a mean of 30 months in which half of patients were assigned to antihypertensive treatment and the other half to placebo, followed by a second phase lasting a mean of 41 months in which all patients were assigned to active antihypertensive treatment.
A total of 66,668 patients received active therapy (an ACE inhibitor, diuretic, or beta blocker) and 66,186 received placebo during the initial phase.
In all, 11,988 patients died during the first phase.
The researchers' analysis showed that patients receiving active treatment had 16% lower total mortality than those taking placebo (p<0.0001).
In the second phase of the trials, during which 7249 patients died, the median rates of antihypertensive medication use in patients initially on active therapy and placebo were similar, at 59% and 43%, respectively.
Despite the similar antihypertensive treatment rates in this phase, those who received active treatment in the first phase had a 15% lower mortality risk than those who had taken placebo initially (p<0.0001).
Of note, the persistent mortality risk reduction seen among the initial active treatment group occurred irrespective of the class of antihypertensive used and medical indication for which the medication was given (ie, hypertension, MI, or LVSD).
Kostis and team conclude: "The data imply that earlier initiation of [antihypertensive] therapy will result in significant clinical benefits."
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By Lauretta Ihonor