HypertensionMeta-analysis
Heart rate-lowering drugs and outcomes in hypertension and/or cardiovascular disease: a meta-analysis
- Systematic review and meta-analysis of randomised trials
- random-effects model
Authors' conclusion
The HR reduction benefits are context-dependent.
Study context
- Population
- Patients with hypertension and/or CVD
- Participants
- 157,764 patients · 74 trials
- Comparison
- HR-lowering drugs vs placebo or less intensive treatment
Pooled result
As reported in the abstract
CV outcomes, mortality and adverse events · 2.7 years
- Average HR reduction (b.p.m.)
- 8.2
- Baseline/attained HR (b.p.m.)
- 76.2/65.6
- CHD reduced by
- 16%
- HF reduced by
- 9%
- Cardiovascular (CV) mortality reduced by
- 14%
- All-cause mortality reduced by
- 13%
Further pooled results
Mortality, post-acute MI and HF (subgroups)
- Significant mortality reductions
Outcomes, hypertension without CVD (subgroup)
- No significant outcome changes
- Entire hypertensive population: increased stroke and mortality
Outcomes by HR threshold (≥80 to almost 70 b.p.m.)
- Effect not different across cutoffs, except for HF
Outcomes by attained HR target (≥70 to <65 b.p.m.)
- Not different across progressively lower targets, except permanent discontinuations (incremental trend)
Safety
Adverse event-driven discontinuations
- Increased by
- 25%
Original publication
Heart rate-lowering drugs and outcomes in hypertension and/or cardiovascular disease: a meta-analysis. Eur Heart J. Published 25 April 2025. doi:10.1093/eurheartj/ehaf291
Summarised from the published abstract; every number is checked against it