Author + information
- William J. Kostis,
- Jeanne M. Dobrzynski,
- Jerry Cheng,
- Abel E. Moreyra and
- John B. Kostis
Background: In a comprehensive meta-analysis of trials of antihypertensive agents, we reported that diuretics are associated with a lower odds ratio (OR) of incident heart failure at follow-up.
Methods: In a new meta-analysis of 16 randomized clinical trials (87,187 patients, 2,793 events), we examined the relationship of the OR of incident heart failure during follow-up to the OR of dropping out of a given trial due to adverse events.
Results: Overall, the lower the OR of incident heart failure during follow-up, the higher the trial dropout rate, slope -0.24 (95% confidence interval [CI]: -0.56 to 0.03). Diuretics were superior in decreasing the OR of incident heart failure, OR 0.42 (95% CI: 0.33 to 0.54), however, the OR of dropping out was 2.4 times higher with these agents (2.42, 95% CI: 1.51 to 3.90). Intensive blood pressure control, regardless of the medication class used, was associated with a trend toward lower OR of dropping out (1.14, 95% CI: 0.84 to 1.54), but with higher OR of incident heart failure (0.80, 95% CI: 0.51 to 1.27). Other treatment classes showed intermediate findings.
Conclusions: There is a reciprocal relationship between the benefit of antihypertensive therapy in preventing incident heart failure and the dropout rate in clinical trials. This is an important consideration in the clinical management of hypertension, especially in the post-SPRINT (Systolic Blood Pressure Intervention Trial) era when lower blood pressure targets may be recommended.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-295
- 2017 American College of Cardiology Foundation