[Arterial hypertension: current large therapeutic trials].
In this review, the design and objectives of ongoing clinical trials in essential hypertension are discussed along with the main results obtained from previously published therapeutic trials. In a meta-analysis of 14 of the major primary prevention trials in hypertension, the difference in diastolic blood pressure between the intervention groups and the control groups was only 5-6 mmHg. This difference was associated with significant reductions in all stroke events (42 per cent), all coronary heart disease events (14 per cent) and in cardiovascular mortality (21 per cent). In elderly hypertensive patients, available studies have shown that antihypertensive treatment reduces the incidence of non-fatal cardiovascular events without significantly modifying cardiovascular mortality. Most of these results were obtained with beta-blockers or diuretics. Despite official recommendation as first line monotherapy, none of the three new antihypertensive classes has been shown to have beneficial effects on hard primary endpoints such as cardiovascular morbidity and mortality. Several ongoing large scale randomized controlled trials vs. beta-blockers or diuretics are addressing this important issue. Moreover, other effects of antihypertensive treatment such as the 'J-curve phenomenon', the rate of change in the carotid wall thickness or the exact beneficial effects in elderly patients are being investigated in some of these studies.
Chalon
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S
Service de Pharmacologie Clinique, CHU Pitié-Salpêtrière, Paris.
Brudi
P
P
Lechat
P
P
D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D009017:Morbidity
D000959:Antihypertensive Agents
Hypertension artérielle: les grands essais thérapeutique en cours.