HTN Trials (IPFC 3)

BPLTTC 2015

P: 1*, mild HTN

I: antiHTN therapy

C: no antiHTN therapy

O: reduced stroke/all cause mortality/CV death, no sig reduction in HF and total CV events

take home: pts with mild HTN had no CVD benefit from treatment

BPLTTC 2021

P: 1* and 2*, with and without CVD

I: BP meds

C: no treatment

O: benefits start at SBP 140, reduced major CV outcomes

take home: supports starting treatment at 140/90

Journal of HTN Analysis

P: SBP 120-139mmHg

I: BP treatment

C: no treatment

O: reduced stroke and CHD, no overall CV benefit

take home: does not support treating “normal” BP (120-139)

Isolated Systolic HTN trial

P: 60+, isolated systolic HTN, CV risk

I: anti HTN therapy

C: no therapy

O: benefit seen once SBP reduced to 140mmHg

take home: treat isolated systolic HTN in older adults

SPRINT trial **

P: mostly 1*, SBP >130, high CV risk, no DM

I: intensive BP target (<120)

C: standard target (<140)

O: reduced composite CV events/CV death/HF/all cause mortality, no sig reduction in stroke/MI/ACS, increased hypotension and AKI, stopped early due to benefit

take home: intensive BP lowering improves outcomes in high risk nonDM pts but increases AEs

Short Acting CCB trial

P: HTN with previous MI

I: short acting CCB

C: B blocker or diuretic

O: high CV AEs

take home: avoid short acting CCBs in HTN

B Blocker Efficacy Trial

P: HTN, general pop

I: B blockers

C: other HTN classes

O: B blockers less effective for stroke/CVD/renal outcomes/mortality, CCB better for stroke but worse for HF, diuretics best for HF

take home: B blockers not 1st line unless compelling indication

ALLHAT trial **

P: 1*, 55y+, HTN, 1+ CHD risk factor

I: chlorthalidone, amlodipine, lisinopril, (doxazosin)

C: compared against each other

O: doxazosin stopped early (increase HF), chlorthalidone as effective as new drugs and better for HF and stroke (than lisinopril), amlodipine worse for HF, lisinopril worse for stroke

take home: chlorthalidone excellent 1st line med

HCTZ vs Chlorthalidone trial

P: 65y+, HTN, on HCTZ

I: switch to chlorthalidone

C: continue HCTZ

O: no diff in clinical outcomes

take home: both were similar but chlorthalidone preferred because of ALLHAT and its longer duration of action

ACCOMPLISH trial **

P: 60y+, HTN, high CV risk, CVD/CKD/DM/end organ damage, HF excluded

I: benazepril + amlodipine

C: benazepril + HCTZ

O: ACEi + CCB reduced CV events, no diff in all cause mortality, trial stopped early due to benefit

take home: ACEi + CCV > ACEi + HCTZ in high risk pts

Primary Prevention ASA trial

P: 1*, 40y+, no CVD

I: ASA
C: placebo

O: reduced non fatal MI and all cause mortality, no reduction in non fatal stroke or CV mortality, increased major GI bleeds and hemorrhagic stroke

take home: ASA has limited benefit in 1* prevention, bleed > CV benefit