Copyright © 2003 by the European Society of Cardiology.
Clinical perspective
Outcome beyond blood pressure control?
a Study Coordinating Centre, Laboratory of Hypertension, Department of Molecular and Cardiovascular Research, University of Leuven, Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
b Erasmus University, Rotterdam, The Netherlands
* Corresponding author. Tel.: +32-16-34-7104; fax: +32-16-34-7106
E-mail address: jan.staessen@med.kuleuven.ac.be
Received 22 October 2002; accepted 23 October 2002
Key Words: Cardiovascular complications • Coronary heart disease • Hypertension • Stroke
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1. Introduction
The last two decades witnessed the publication of a large number of clinical outcome trials of blood pressure lowering agents in hypertensive patients or normotensive subjects with a high cardiovascular risk profile. Placebo-controlled trials of antihypertensive drug treatment in middle-aged or older hypertensive patients predominantly with diastolic hypertension1 proved that a 5–6mmHg decline in diastolic pressure maintained over 5 years diminished the incidence of stroke by nearly 40% and that of coronary endpoints by 15%. Similarly, in older patients with isolated systolic hypertension, pharmacological intervention during 4 years reduced systolic pressure on average by 10mmHg and decreased cardiovascular mortality by 18%, all cardiovascular complications by 26%, stroke by 30%, and coronary events by 23%.2
Until recently, the consensual interpretation of the evidence produced by the outcome trials in hypertensive patients3–39 was that blood pressure is a risk factor amenable to intervention, lower levels leading to fewer complications. However, the HOPE
2. Older vs newer antihypertensive drugs
3. Secondary prevention trials in high-risk patients
4. A meta-regression analysis
5. Benefit beyond blood pressure lowering?
6. Economic implications of trial results
7. Perspective on future trials in hypertension
8. Conclusions
Appendix A—Acronyms of trials
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