Article: Meta-analysis of large outcome trials of angiotensin receptor blockers in hypertension

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TitleMeta-analysis of large outcome trials of angiotensin receptor blockers in hypertension
AuthorsCheung, BMY1
Cheung, GTY1
Lauder, IJ1
Lau, CP1
Kumana, CR1
KeywordsChemicals And Cas Registry Numbers
Issue Date2006
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/jhh
CitationJournal Of Human Hypertension, 2006, v. 20 n. 1, p. 37-43 [How to Cite?]
DOI: http://dx.doi.org/10.1038/sj.jhh.1001931
AbstractAngiotensin receptor blockers (ARBs), also known as sartans, block the activation of angiotensin type 1 receptors and have a recognised role in the treatment of heart failure and nephropathy. Since 2002, there have been three major outcome trials of ARBs in hypertension. We performed a meta-analysis to evaluate the impact of ARB on major outcomes. Randomised controlled trials of ARBs in hypertensive subjects with an average follow-up of at least 2 years and at least 100 major cardiovascular events were included. For each trial, the ARB used, number and characteristics of subjects, baseline and change in blood pressure, cardiovascular and noncardiovascular outcomes were recorded. Three trials involving 29375 subjects were included in the meta-analysis. In Losartan Intervention For Endpoint (LIFE) and Study on Cognition and Prognosis in the Elderly (SCOPE) but not in Valsartan Antihypertensive Long-term Use Evaluation trial (VALUE), an ARB reduced the occurrence of the primary end point and stroke compared to control. Compared to other antihypertensive drugs, ARB treatment was associated with no significant change in all-cause mortality (relative risk ratio (RRR) 0.96, 95% CI: 0.88-1.06, P = 0.45). There was an increase in myocardial infarction (RRR, 1.12, 95% CI: 1.01-1.26, P = 0.041), but a decrease in new-onset diabetes mellitus (RRR, 0.80, 95% CI: 0.74-0.86, P < 0.0000001). In conclusion, the reduction in new-onset diabetes partly offsets any increase in the risk of myocardial infarction. Most hypertensive patients require more than one class of drugs. Small differences in treatment outcome should not over-ride the importance of good blood pressure control. © 2006 Nature Publishing Group. All rights reserved.
ISSN0950-9240
2011 Impact Factor: 2.802
2011 SCImago Journal Rankings: 0.206
DOIhttp://dx.doi.org/10.1038/sj.jhh.1001931
ISI Accession Number IDWOS:000233971400006
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorCheung, BMY
dc.contributor.authorCheung, GTY
dc.contributor.authorLauder, IJ
dc.contributor.authorLau, CP
dc.contributor.authorKumana, CR
dc.date.accessioned2010-09-17T10:20:11Z
dc.date.available2010-09-17T10:20:11Z
dc.date.issued2006
dc.description.abstractAngiotensin receptor blockers (ARBs), also known as sartans, block the activation of angiotensin type 1 receptors and have a recognised role in the treatment of heart failure and nephropathy. Since 2002, there have been three major outcome trials of ARBs in hypertension. We performed a meta-analysis to evaluate the impact of ARB on major outcomes. Randomised controlled trials of ARBs in hypertensive subjects with an average follow-up of at least 2 years and at least 100 major cardiovascular events were included. For each trial, the ARB used, number and characteristics of subjects, baseline and change in blood pressure, cardiovascular and noncardiovascular outcomes were recorded. Three trials involving 29375 subjects were included in the meta-analysis. In Losartan Intervention For Endpoint (LIFE) and Study on Cognition and Prognosis in the Elderly (SCOPE) but not in Valsartan Antihypertensive Long-term Use Evaluation trial (VALUE), an ARB reduced the occurrence of the primary end point and stroke compared to control. Compared to other antihypertensive drugs, ARB treatment was associated with no significant change in all-cause mortality (relative risk ratio (RRR) 0.96, 95% CI: 0.88-1.06, P = 0.45). There was an increase in myocardial infarction (RRR, 1.12, 95% CI: 1.01-1.26, P = 0.041), but a decrease in new-onset diabetes mellitus (RRR, 0.80, 95% CI: 0.74-0.86, P < 0.0000001). In conclusion, the reduction in new-onset diabetes partly offsets any increase in the risk of myocardial infarction. Most hypertensive patients require more than one class of drugs. Small differences in treatment outcome should not over-ride the importance of good blood pressure control. © 2006 Nature Publishing Group. All rights reserved.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationJournal Of Human Hypertension, 2006, v. 20 n. 1, p. 37-43 [How to Cite?]
DOI: http://dx.doi.org/10.1038/sj.jhh.1001931
dc.identifier.citeulike304053
dc.identifier.doihttp://dx.doi.org/10.1038/sj.jhh.1001931
dc.identifier.eissn1476-5527
dc.identifier.epage43
dc.identifier.isiWOS:000233971400006
dc.identifier.issn0950-9240
2011 Impact Factor: 2.802
2011 SCImago Journal Rankings: 0.206
dc.identifier.issue1
dc.identifier.pmid16121197
dc.identifier.scopuseid_2-s2.0-33644939620
dc.identifier.spage37
dc.identifier.urihttp://hdl.handle.net/10722/91486
dc.identifier.volume20
dc.languageeng
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/jhh
dc.publisher.placeUnited Kingdom
dc.relation.ispartofJournal of Human Hypertension
dc.relation.referencesReferences in Scopus
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshAngiotensin II Type 1 Receptor Blockers - therapeutic use
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshHypertension - drug therapy
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshRandomized Controlled Trials as Topic
dc.subject.meshRetrospective Studies
dc.subject.meshTreatment Outcome
dc.subjectChemicals And Cas Registry Numbers
dc.titleMeta-analysis of large outcome trials of angiotensin receptor blockers in hypertension
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong