From the Guidelines
The findings from the attached medical information suggest that antihypertensive treatment can significantly reduce the risk of cardiovascular disease events and all-cause mortality in persons without hypertension, with a history of cardiovascular disease or cardiovascular disease equivalents such as diabetes. The study 1 included in the meta-analysis incorporated data from 64,162 participants without hypertension, and the results showed a significant reduction in risk for fatal or nonfatal stroke, CHF events, composite CVD events, and all-cause mortality. Some key points from the study include:
- A 23% reduction in risk of stroke (RR, 0.77 [95% CI, 0.61 to 0.98])
- A 20% reduction in risk of MI (RR, 0.80 [95% CI, 0.69 to 0.93])
- A 29% reduction in risk of CHF events (RR, 0.71 [95% CI, 0.65 to 0.77])
- A 15% reduction in risk of composite CVD events (RR, 0.85 [95% CI, 0.80 to 0.90])
- A 17% reduction in risk for CVD mortality (RR, 0.83 [95% CI, 0.69 to 0.99])
- A 13% reduction in risk for all-cause mortality (RR, 0.87 [95% CI, 0.80 to 0.95]) The study also found that the association of antihypertensive treatment and composite CVD outcome or all-cause mortality did not differ significantly by trial characteristics, and the results were consistent across subgroups. Another study 1 published in 2021, provides an update on the guideline-driven management of hypertension, and highlights the importance of out-of-office BP readings, lifestyle modification, and intensive BP control in the management of hypertension. Some key points from this study include:
- Out-of-office BP readings (ABPM or HBPM) are recommended to detect WCH and MH
- HBPM is the most practical method to document BP for medication titration towards the achievement and maintenance of BP goal
- Autonomous aldosterone production may play a role in the pathogenesis of Stages 1 and 2 hypertension and resistant hypertension
- Lifestyle modification continues to be the cornerstone of antihypertensive therapy, and each nonpharmacological intervention is effective in lowering BP
- Intensive BP control is not associated with increased hospitalization and does not increase the risk of orthostatic hypotension.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Findings from Medical Studies
The attached medical information includes studies on the effects of various medications on blood pressure, glucose metabolism, and lipid profiles. The key findings are:
- Lisinopril, an ACE inhibitor, lowers blood pressure and preserves renal function in hypertensive patients with diabetes mellitus, without adversely affecting glycaemic control or lipid profiles 2.
- Metformin has an antihypertensive effect in essential hypertensive patients with hyperinsulinemia, similar to fosinopril, and the two drugs have a good synergy 3.
- Metformin-based treatment reduces weight, BMI, waist circumference, and visceral adiposity, and lowers serum high-sensitivity C-reactive protein levels in obese hypertensive patients without diabetes, but has no effect on blood pressure and blood glucose levels 4.
- Lisinopril and hydrochlorothiazide, a diuretic, have different effects on glucose and lipid metabolism in essential hypertension, with lisinopril having a more favorable profile 5.
- Metformin attenuates the postprandial fall in blood pressure in type 2 diabetes, associated with augmented GLP-1 secretion and delayed gastric emptying 6.
Key Effects of Medications
Some of the key effects of the medications studied are:
- Lisinopril: lowers blood pressure, preserves renal function, and has a renoprotective effect in patients with diabetes mellitus 2.
- Metformin: reduces weight, BMI, waist circumference, and visceral adiposity, and lowers serum high-sensitivity C-reactive protein levels in obese hypertensive patients without diabetes 4, and attenuates the postprandial fall in blood pressure in type 2 diabetes 6.
- Fosinopril: has an antihypertensive effect in essential hypertensive patients with hyperinsulinemia, similar to metformin 3.
- Hydrochlorothiazide: increases insulin and C-peptide concentrations, and decreases plasma high density cholesterol concentrations in essential hypertension 5.