Concerns for the Heart Failure Reduction in the NAGOYA HEART Study Based on Meta-Regression From the Evidence

Abstract

The NAGOYA HEART Study1 compared the efficacies of an angiotensin II type 1 receptor blocker (ARB) valsartan and a calcium channel blocker amlodipine on cardiovascular morbidity and mortality as a primary outcome in Japanese hypertensive patients with glucose intolerance. Time-to-event curves for primary outcomes did not significantly differ between the 2 groups (hazard ratio, 0.97; 95% confidence interval [CI], 0.66–1.40; P =0.85). Despite no significant differences in the risk of myocardial infarction, stroke, coronary revascularization, or sudden cardiac death between the 2 groups, the incidence of admission because of heart failure was significantly less in the valsartan group than that in the amlodipine group (hazard ratio, 0.20; 95% CI, 0.06–0.69; P =0.012). It seems strange, however, that the achieved blood pressure (BP) between the 2 groups is almost the same (131/73 mm Hg in the valsartan group and 132/74 mm Hg in the amlodipine group at 54 months). Herein, we would like to assess the specificity of the significant relative risk reduction for heart failure with …