Effects of Blood Pressure Lowering Agents on Cardiovascular Outcomes in Weight Excess Patients: A Systematic Review and Meta-analysis.

Abstract

BACKGROUND:

Obesity hypertension is an ongoing pandemic. The first-line medications to treat this condition are still subject to debate. We compared diuretics, calcium-channel blockers (CCB), beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) as an initial antihypertensive therapy for prevention of cardiovascular morbimortality of hypertensive individuals who are overweight or obese.

METHODS:

We conducted a search of the literature for randomized clinical trials in which at least 50% of the participants were overweight or obese. The primary outcomes were all-cause mortality, cardiovascular mortality, acute myocardial infarction (MI), heart failure (HF), stroke, or end-stage renal disease.

RESULTS:

Our search yielded 16 randomized studies. Comparisons of two classes of drugs with at least two studies indicated that (1) CCB and ACEI increased the risk of HF [relative risk (RR) = 2.26; 95% confidence interval (CI) 1.16-4.40] and stroke [hazard ratio (HR) = 1.13; 1.00-1.26]), respectively, compared to diuretics; and (2) CCB showed a reduction in stroke (HR = 0.77; 0.66-0.89) and total mortality (HR = 0.94; 0.87-1.01) compared to the BB atenolol. Comparisons of two classes of antihypertensive medications with only one study showed that the risk of MI was higher with ARB valsartan versus CCB (HR = 1.19; 95% CI 1.02-1.38, p = 0.02). In contrast, losartan lowered the risk of a composite cardiovascular outcome compared to atenolol (HR = 0.87; 95% CI 0.77-0.98, p = 0.02).

CONCLUSIONS:

In hypertensive subjects with excess weight, diuretics are more effective for preventing HF and stroke than CCB and ACEI, respectively. CCB are a good first-line choice for prevention of cardiovascular disease, except HF.

• Authors: Emilio Antonio Francischetti, Virginia Genelhu de Abreu, Luiz Felipe da Silva Figueiredo, Rômulo Sperduto Dezonne, Evandro Silva Freire Coutinho
• Journal: American journal of cardiovascular drugs : drugs, devices, and other interventions (Am J Cardiovasc Drugs) Vol. 20 Issue 5 Pg. 447-470 (Oct 2020) ISSN: 1179-187X [Electronic] New Zealand
• PMID: 31898196 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Antihypertensive Agents

Topics

• Antihypertensive Agents (classification, pharmacology)
• Cardiometabolic Risk Factors
• Cardiovascular Diseases (mortality, prevention & control)
• Humans
• Hypertension (drug therapy, etiology)
• Obesity (diagnosis, physiopathology)
• Randomized Controlled Trials as Topic