title: 'Beyond blood pressure' means multiple risk factor intervention, not pleiotropic antihypertensive drugs.
abstract: OBJECTIVE
  We examined the role of blood pressure-lowering compared with class-specific properties of antihypertensive drugs in cardiovascular prevention.
  
  
  RESULTS
  We reviewed recently published trials and meta-regression analyses.
  
  
  CONCLUSIONS
  From 150,000 to 180,000 randomized patients followed up from 3 to 5 years were required to demonstrate a 10-15% benefit 'beyond blood pressure lowering' of newer antihypertensive drugs, such as calcium channel blockers or angiotensin-converting enzyme inhibitors in the prevention of cause-specific cardiovascular complications. Assuming an absolute risk of new-onset diabetes mellitus on older drugs of approximately 10% over 5 years and a relative benefit on the newer drugs of approximately 30%, about 100 patients would have to be treated for 5 years with the newer agents to avert approximately three iatrogenic cases of diabetes. Whether or not new-onset diabetes is associated with increased risk is uncertain. In most patients, optimization of treatment at acceptable tolerance requires rotation through and combination of several drug classes. Combination of different classes of antihypertensive drugs not only enhances the blood pressure-lowering efficacy, but likely decreases the risk of metabolic adverse effects as well. True benefit beyond blood pressure lowering in hypertensive patients comes from multiple risk factor intervention.
authors.affiliation: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. jan.staessen@proximus.be
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Tatiana
authors.initials: T
authors.lastname: Kuznetsova
authors.forename: Tom
authors.initials: T
authors.lastname: Richart
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.forename: Willem H
authors.initials: WH
authors.lastname: Birkenhäger
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control; D048909:Diabetes Complications / Q000517:prevention & control; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics