Page 10 - hypertension_newsletter4_Final

REFLECTIONS
Hypertension
Hypertension Global Newsletter #4 2023

Aggregate data from four published RCTs involving 24,194 patients (active: 12,113; placebo: 12,082) were analyzed. The
studies included: Post-stroke Antihypertensive Treatment Study (PATS), a two-year study (indapamide); Perindopril pROtection
aGainst REcurrent Stroke Study (PROGRESS), a four-year study (indapamide and perindopril), both in patients with a history
Hypertension
of stroke or transient ischemic attack; Action in Diabetes and Vascular disease (ADVANCE), a four-year study in patients with
T2DM and CV risk factor (single-pill combination perindopril/indapamide); and Hypertension in the Very Elderly Trial (HYVET),
a two-year study in very elderly hypertensive individuals (indapamide and an option of perindopril). See table above for main
features of the four studies.

Statistically significant risk reductions in the indapamide
with or without perindopril-treated patients as compared to
placebo were observed for all-cause death (-15%), CV death
(-21%), fatal stroke (-36%), and all strokes (-27%). Pooling
together monotherapy and combination with perindopril
reflects the pragmatic considerations of initiating treatment
with either a mono or combined therapy according to the
current guidelines. The fixed-effects meta-analysis of the
endpoints found low statistical heterogeneity (I2=0) for all
mortality endpoints.

There was high heterogeneity in the treatment effects
between the studies for other endpoints. However, all other
CV morbidity endpoints were numerically improved with
risk reductions varying from 22–36% as compared with
placebo (-22% for major coronary events, -25% for major
cardiovascular events, -26% for MI, -27% for stroke, and
-36% for heart failure.

Treatment discontinuation rates were available in two studies
(PROGRESS and ADVANCE). In both studies, treatment
discontinuation for any reason was similar in the active and
placebo groups (active: 18.4%; placebo: 18.0%) whereas
treatment discontinuation for safety reasons (including
hypotension, dizziness, and cough) was numerically higher
in the active (6.4%) compared with placebo-treated (3.9%)
patients.
CLINICAL PEARLS FROM THE FACULTY
Across relatively diverse medium to high CV risk patient
populations, long-term indapamide with or without perindopril-
based treatment provided a statistically significant reduction
in all-cause mortality, CV death and fatal stroke, and total
stroke. This pooled analysis confirms the benefits of this
treatment in managing high BP.

WATCH
PROF. CAMARGO DISCUSS HER
THOUGHTS ON THE SIGNIFICANCE OF
THESE RESULTS FOR PATIENTS WITH
CLICK HERE MEDIUM TO HIGH CV RISK IN CLINICAL
FOR THE LINK TO FULL ARTICLE PRACTICE.

TABLE OF CONTENTS