Updates in hypertension studies according to the main clinical trials: A review of the past 45 years about pharmaceutical intervention effects

Abstract

Background: High blood pressure remains one of the most important risk factors for cardiovascular disease. Although there is no consensus, all the clinical practice guidelines agree on the need to reduce blood pressure levels to minimize the risks. There are many clinical trials conducted to try to find the best pharmacotherapy to achieve this goal. The aim was to compare the main international randomized clinical trials on hypertension in people older than 50 years. Methods: Literature qualitative review of randomized clinical trials selected from PubMed and UpToDate in people older than 50 years, from 1985 until 2020. The clinical trials conducted during this period show variability in the drugs used, the inclusion criteria for blood pressure figures, and the consideration or not of other vascular risk factors (smoking, obesity, lipid disorders, diabetes, and physical inactivity). Results: Of the 8334 articles found, 19 of them fulfilled the inclusion and exclusion criteria that involved 202,638 people. The main findings of each investigation were grouped as follows: incidence of non-cardiovascular death, death of cardiovascular origin, coronary heart disease, cerebrovascular disease, renal failure, and hypertensive retinopathy. In all patients, blood pressure figures were reduced, although this did not always lead to statistically significant differences in morbidity and/or mortality risk reduction. Twelve of them found risk reduction as an effect of reduced blood pressure. Conclusions: Randomized clinical trials conducted on hypertension in people older than 50 years of age show variability in the inclusion criteria. Variability in the antihypertensive drugs used was observed in this population. Blood pressure figures were reduced in all cases, although without statistically significant differences in morbidity and/or mortality risk reduction.