Which antihypertensive drug classes have been shown to be beneficial? What are their benefits? A critique of hypertension treatment trials.

Abstract

Antihypertensive drug treatment trials and meta-analyses thereof have been reviewed. Disturbing inaccuracies and inconsistencies have been exposed. Some commentators have excluded certain trials from consideration for explicit reasons on one occasion, and then unaccountably relaxed their rigor subsequently. Most problematic and notorious have been the varied evaluations of the large American HDFP study, which compared patients allocated to two quite different health care systems, addressed multiple risk factors additional to hypertension, and employed very questionable definitions of nonfatal coronary events. Data from this large and pervasive study especially have polluted several meta-analyses and treatment guidelines. There have been several exaggerated claims of benefit concerning coronary artery disease and all-cause mortality.