Effects of blood pressure lowering drugs in heart failure: a systematic review and meta-analysis of randomised controlled trials

We aimed to combine evidence from all heart failure trials that have investigated the effects of drugs with blood pressure lowering properties to assess (1) the extent to which such drugs reduce blood pressure in heart failure, (2) the association between the net change in blood pressure between treatment arms and cause-specific outcomes, and (3) whether treatment effects (efficacy and safety) vary according to baseline blood pressure. We conducted a systematic review and meta-analysis including randomised clinical trials of drugs with blood pressure-lowering properties in patients with chronic heart failure with at least 300 patient-years follow-up. We included a total of 37 trials (91,950 patients) and showed that treatment with drugs with blood pressure-lowering properties resulted in a small but significant decrease in systolic blood pressure in patients with heart failure with no evidence that the efficacy and safety of those drugs varied according to baseline blood pressure.

Condensed abstract: The relationship between blood pressure and clinical outcomes remains poorly understood. This systematic review and meta-analysis combined evidence from randomised clinical trials of drugs with blood pressure lowering properties in patients with chronic heart failure. It showed that treatment with those drugs achieved a small but significant reduction in systolic blood pressure with no evidence that the efficacy and safety of those drugs varied according to baseline blood pressure.