- Czernichow S, Zanchetti A, Turnbull F et al. Blood Pressure Lowering Treatment Trialists' Collaboration. The effects of BP reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials. J Hypertens 2011; 29: 4-16.
This paper pulls together the results of 32 trials showing that the effectiveness of BP lowering in prevention of cardiovascular events does not depend on starting BP and that additional efforts in those meeting existing targets will produce further benefits.
- Kotseva K, Wood D, De Backer G et al; the Euroaspire Study Group. Euroaspire III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries. Eur J Cardiovasc Prev and Rehab 2010; 17: 530-40.
These data come from a survey of 66 general practices in 12 European countries suggesting that BP remains poorly diagnosed and controlled, lipid and glucose control are inadequate and that lifestyle issues also remain a cause for concern with a high prevalence of persistent smoking and obesity.
- Yusuf S, Teo K, Pogue J et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547-59.
This was a study in more than 24,000 patients demonstrating equivalence between telmisartan (an ARB) and ramipril (an ACE inhibitor) for cardiovascular outcomes. The combination of an ARB with an ACE inhibitor in this study was of no additional benefit but was associated with more side-effects.
Guidelines
- NICE. The clinical management of primary hypertension in adults. CG127. London, NICE, 2011. http://guidance.nice.org.uk/CG127/Guidance/pdf/English
Curriculum
- This topic falls under section 15.1 of the RCGP curriculum, Cardiovascular problems.
Contributed by Dr Klaus Witte, senior lecturer and honorary consultant cardiologist, University of Leeds and Leeds General Infirmary
