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(Hypertension. 2005;46:257.)
© 2005 American Heart Association, Inc.

Editorial Commentaries

An Updated Meta-Analysis With a Few Surprises

From the UT Southwestern Medical Center, Dallas, Tex.

Correspondence to Norman M. Kaplan, MD, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8899. E-mail norman.kaplan@utsouthwestern.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The meta-regression analysis by Verdecchia et al in this issue of Hypertension¹ updates the 2003 analyses of Staessen et al² and the Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC).³ It includes the 5 trials published after those 2003 manuscripts were composed.

All 5 of the additional studies were secondary prevention trials, all on patients with known coronary heart disease (CHD).^4–8 In 4 of the 5, either an angiotensin-converting enzyme inhibitor (ACEI) or a calcium channel blocker (CCB) was compared with a placebo, providing an additional 3.0 to 6.1 mm Hg further reduction in the mean systolic blood pressure. In all of these 4 trials of ACEI or CCB versus placebo, patients were also receiving other antihypertensive drugs, mainly directly toward their coronary disease.

The new analysis¹ confirms and strengthens the conclusion of the previous^2,3 analyses: when compared against placebo, ACEIs and CCBs protect against myocardial infarction (MI) and stroke; when compared against older drugs (diuretics and ß-blockers), neither ACEIs nor CCBs add much more protection against either stroke or MI. However, as shown previously, ACEIs provide better coronary protection than CCBs, whereas CCBs provide better stroke protection than ACEIs.

Unlike the 2003 analyses, this one does not examine the effects of these drugs on congestive heart failure, in which ACEIs (and angiotensin II receptor blockers) have been found to be particularly effective.

One of the new trials, the International Verapamil-Trandolapril Study (INVEST), examined CCB-based therapy against ß-blocker–based therapy.⁵ Many more such comparative trials are in process, one having been completed . . . [Full Text of this Article]