Hypertension, a prominent cause of premature mortality, affects ~1.13 billion people worldwide, though blood pressure (BP) control rates remain dismal at <20%. (1) Though several trials have shown that BP-lowering with antihypertensive agents is an effective strategy for reducing cardiovascular (CV) risk, the treatment and control rates of patients with hypertension (BP>140/90 mm Hg) across the world remain disappointing.
The Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) sought to analyse individual patient-level data (IPD) from 3,48,854 participants from 48 clinical trials across the world 2 to determine the efficacy of BP-lowering for prevention of CV events across different levels of BP. (3)
The participants in the analysis were primarily split into two groups - with and without prior diagnosis of CV disease. Each group was additionally subdivided into 7 groups based on the individual's baseline systolic BP (i.e. at study entry). The BP thresholds (in mmHg) for this subdivision were 1) <120, 2)120- 129, 3) 130-139, 4) 140-149, 5) 150-159, 6) 160-169 and 7) ≥
170 with an average follow-up of 4 years.
Amongst the available antihypertensive agents, Amlodipine continues to be regarded as the "GOLD STANDARD" in terms of BP reduction. (5) This aspect is well-substantiated with the presence of outcome data via several long-term landmark trials which show that Amlodipine-based regimens successfully reduce CV morbidity and mortality. (6),(7)
The reduction in CV events was further confirmed by a meta-analysis of 7 large-scale, actively controlled, long-term outcome trials which showed that compared to non-calcium channel blocker (CCB) antihypertensive therapy, Amlodipine-based regimens decreased myocardial infarction by 9%, stroke by 16%, total CV events by 10% and total mortality by 7%. (8)
Amlodipine's effectiveness in lowering BP along with its excellent tolerability and minimal side effects has made it a preferred agent across the globe as a part of both single and combination drug regimens targeted towards decreasing CV disease burden. 7,9 Amlodipine, which has been in use for >2 decades, should thus be considered a first-line antihypertensive agent for the management of hypertension, not only for its BP-lowering effect but also for safely improving CV outcomes in patients. (9)
1. Hypertension. WHO [Internet] 2019 [cited 2020 Sep 30] Available from https://www.who.int/news- room/fact-sheets/detail/hypertension
2. Rahimi K, Canoy D, Nazarzadeh M, Salimi-Khorshidi G, Woodward M, Teo K, Davis BR, Chalmers J, Pepine CJ; Blood Pressure Lowering Treatment Trialists' Collaboration. Investigating the stratified efficacy and safety of pharmacological blood pressure-lowering: an overall protocol for individual patient-level data meta-analyses of over 300 000 randomised participants in the new phase of the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC). BMJ Open. 2019 May 22;9(5):e028698.
3. BPLTTC Science News from ESC 2020. American Heart Association [Internet] 2020 [cited 2020 Sep 30] Available from https://professional.heart.org/-/media/phd-files/meetings/esc/2020/bplttc.pdf?la=en
4. Blood pressure-lowering is even more beneficial than previously thought BPLTTC trial presented in a Hot Line Session today at ESC Congress 2020. ESC Press Office [Internet] 2020 [cited 2020 Sep 30] Available from https://www.escardio.org/The-ESC/Press-Office/Press-releases/Blood-pressure-lowering-is-even- more-beneficial-than-previously-thought
5. Neutel J, Smith DH. Evaluation of angiotensin II receptor blockers for 24-hour blood pressure control: meta-analysis of a clinical database. J Clin Hypertens (Greenwich). 2003 Jan-Feb;5(1):58-63.
6. de la Sierra A. Amlodipine in the Prevention and Treatment of Cardiovascular Disease. European Cardiology Reviews 2007;3(2):66-68.
7. Owen AJ, Reid CM. Cardio classics revisited: focus on the role of amlodipine. Integr Blood Press Control. 2012;5:1-7.
8. Lee SA, Choi HM, Park HJ, Ko SK, Lee HY. Amlodipine and cardiovascular outcomes in hypertensive patients: meta-analysis comparing amlodipine-based versus other antihypertensive therapy. Korean J Intern Med. 2014 May;29(3):315-24.
9. Fares H, DiNicolantonio JJ, O'Keefe JH, Lavie CJ. Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes. Open Heart. 2016 Sep 28;3(2):e000473.