Hypertension Treatment Shouldn't Be Tailored to Patient Adiposity.

[Argirios Argiriou]

November 18, 2014.

Hypertension Treatment Shouldn't Be Tailored to Patient Adiposity.
Bruce Soloway, MD reviewing Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2014 Nov 4. Franklin SS and Weber MA. Lancet 2014 Nov 4.

In a meta-analysis of various antihypertensive regimens, body-mass index did not influence effectiveness.

Hypertension is more common in obese patients than in lean ones, and its pathophysiology might differ depending on adiposity. Recent studies have suggested that the effectiveness of certain antihypertensive medications to prevent major adverse cardiovascular (CV) events varies with patient weight (NEJM JW Gen Med Mar 21 2013). To assess this hypothesis, investigators examined patient-level data, including body-mass index (BMI), from 22 studies (>135,000 patients), in which researchers compared antihypertensive regimens with placebo or other antihypertensive drugs or compared regimens of greater or lesser intensity. Comparative effectiveness was analyzed in subgroups of lean, overweight, and obese patients (BMI ranges: <25, 25–30, and ≥30 kg/m2, respectively) and in the patient cohort as a whole, with BMI as a continuous variable.

In the subgroup analyses, in almost all (34 of 36) comparisons of the composite CV outcome (fatal or nonfatal stroke, myocardial infarction, heart failure, or cardiovascular-related death) or specific CV outcomes, regimens were equally effective in all BMI subgroups. When BMI was analyzed as a continuous variable, angiotensin-converting–enzyme inhibitors were slightly but significantly more effective in preventing adverse CV events than were calcium-channel blockers or diuretics in patients with higher BMIs; in all other comparisons between regimens, BMI had no effect.

Comment

Meta-analyses of blood pressure trials often are confounded by heterogeneity between studies, concomitant medications, and other methodological challenges. Nevertheless, the failure of this analysis to show compelling evidence that adiposity alters the cardioprotective effects of any particular antihypertensive regimen argues against using BMI as a factor in selecting antihypertensive therapies.


Citation(s):

    Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: A meta-analysis of randomised trials. Lancet 2014 Nov 4; [e-pub ahead of print]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Franklin SS and Weber MA. Optimum antihypertensive therapy: Does adiposity matter? Lancet 2014 Nov 4; [e-pub ahead of print]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)


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