Newer Is Not Always Better: All Antihypertensive Medications Do Not Equally Reduce Cardiovascular Risk
Hypertension contributes more to cardiovascular mortality than any other modifiable risk factor including cigarette use, elevated LDL cholesterol, obesity, and diabetes.1 Forty-five percent of all cardiovascular deaths are attributable to hypertension. In addition, hypertension is a major risk factor for both stroke and myocardial infarction. In large part due to rising obesity rates, the prevalence of hypertension in the U.S. is increasing. According to the NHANES data, from the early 1990s to the most recently available data from 2005–2008, the prevalence of hypertension has risen from 25.5% to 30.9%.2 The majority of the U.S. elderly are hypertensive: the prevalence is 80% of woman and 67% of men aged 75 years or older. Given the pervasiveness and impact of hypertension, it is critically important to assess the effect of various antihypertensive medications on cardiovascular morbidity. Most studies of antihypertensive medication report proxy outcomes, commonly blood pressure reduction, rather than cardiovascular morbidity, and are of relatively brief duration. Two important questions for clinicians are: 1) Does the degree of blood pressure reduction correspond to the magnitude of cardiovascular risk reduction? and 2) Do all antihypertensive medications equally reduce cardiovascular risk?