Low-Dose Blood Pressure Medication Effectively Treated PreHypertension

MedicalResearch.com Interview with:

Sandra Costa Fuchs, MD, PhD

Dr. Sandra Costa Fuchs

MedicalResearch.com: What is the background for this study?

Response: High blood pressure is the worldwide leading cause of cardiovascular disease. It has been estimated that more than 50%, maybe as much as 70%, of cardiovascular diseases are due to hypertension. Approximately 30% among the Brazilian adult population has hypertension and can reach 70% of individuals over 60 years of age.

Prehypertension (systolic BP 120–139 or diastolic BP 80–89 mm Hg) conveys three potentially deleterious consequences.

  • First, it substantially increases the risk of developing hypertension.
  • Second, patients with prehypertension have evidence of end-organ damage, such as left ventricular geometric and functional abnormalities.
  • Third, there are evidence that adults with prehypertension are at a substantially higher risk of cardiovascular mortality.

The PREVER-Prevention study aimed to assess the efficacy and safety of a low-dose diuretic versus placebo for the prevention of hypertension and end-organ damage.

MedicalResearch.com: What are the main findings?

Response: In this randomized, double-blind, placebo-controlled, clinical trial, 730 participants fulfilled the eligibility criteria and 372 were randomly assigned to treatment with low doses of a thiazide-type diuretic combined with a potassium-sparing agent – chlorthalidone (12.5 mg)/amiloride (5 mg) or placebo (n=358).

The incidence of hypertension was reduced by almost 50% in the chlorthalidone/ amiloride group compared with placebo (11.7% versus 19.5%, respectively) along two years of follow-up.

The intervention was safe, with a similar rate of adverse events in the active and control groups, and promoted a significant reduction in left ventricular mass (LVM) estimated by ECG.

MedicalResearch.com: What should readers take away from this report?

Response: Our findings are aligned with a solid body of knowledge, as the SPRINT trial, suggesting that blood pressure should be maintained below 120/80 mmHg.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The ideal study, a RCT designed to demonstrate the effectiveness of blood pressure treatment to prevent CV events in individuals with prehypertension requires a prohibitively large sample size. Further studies with other surrogate outcomes (target-organ damage), and among other populations, could add more evidences to support the treatment of patients with prehypertension, who do not respond to lifestyle interventions, with low doses of an association of diuretics.

These results were obtained in the context of a randomized clinical trial, conducted among individual patients. Future studies should be implemented in patients of the Health Care System.

MedicalResearch.com: Is there anything else you would like to add?

Response: We may be facing a major change in the hypertension paradigm, which rests on 140/90 mmHg as a historical threshold for diagnosis and goal of treatment. Isn’t time to set 120/80 mmHg as the new paradigm?

I would like to thank to MedicalResearch.com for add visibility to our trial.

Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER‐Prevention Randomized Clinical Trial
Sandra Costa Fuchs, Carlos E. Poli‐de‐Figueiredo, José A. Figueiredo Neto, Luiz César N. Scala, Paul K. Whelton, Francisca Mosele, Renato Bandeira de Mello, José F. Vilela‐Martin, Leila B. Moreira, Hilton Chaves, Marco Mota Gomes, Marcos R. de Sousa, Ricardo Pereira e Silva, Iran Castro, Evandro José Cesarino, Paulo Cesar Jardim, João Guilherme Alves, André Avelino Steffens, Andréa Araujo Brandão, Fernanda M. Consolim‐Colombo, Paulo Ricardo de Alencastro, Abrahão Afiune Neto, Antônio C. Nóbrega, Roberto Silva Franco, Dario C. Sobral Filho, Alexandro Bordignon, Fernando Nobre, Rosane Schlatter, Miguel Gus, Felipe C. Fuchs, Otávio Berwanger, Flávio D. Fuchs
Journal of the American Heart Association. 2016;5:e004248
Originally published December 13, 2016
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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