Episode 402: 410. When You Shouldn't Double Down But Instead Hit for Another

Episode 402: 410. When You Shouldn't Double Down But Instead Hit for Another

This massive meta-analysis of 484 randomized, double-blind, placebo-controlled trials (104,176 participants) quantified the blood pressure–lowering effects of major antihypertensive drug classes and their combinations. It introduces a new intensity-based classification system and an online calculator to predict BP-lowering efficacy based on drug, dose, and baseline BP.



Study Design:

  • 484 trials, 104,176 participants
  • 5 major drug classes: ACE inhibitors, ARBs, β-blockers, calcium channel blockers (CCBs), and diuretics
  • Focus: Placebo-corrected reduction in systolic BP (SBP)
  • Mean baseline BP: 154/100 mm Hg
  • Mean follow-up: 8.6 weeks


Key Findings

Monotherapy (Standard Dose):

  • Average SBP reduction: 8.7 mm Hg
  • By class:
    • ACE inhibitors: 6.8 mm Hg
    • ARBs: 8.5 mm Hg
    • β-blockers: 8.9 mm Hg
    • CCBs: 9.5 mm Hg
    • Thiazide diuretics: 10.8 mm Hg

Dose Doubling:

  • Adds ~1.5 mm Hg SBP reduction (except β-blockers, which add only ~0.5 mm Hg)

Dual Therapy (Standard Dose of Each):

  • Average SBP reduction: 14.9 mm Hg
  • Dose doubling adds ~2.5 mm Hg more

Triple Therapy:

  • SBP reduction: Up to 22.5 mm Hg (quadruple therapy even higher in one trial)

Episoder(388)

Episode 394: 402. Cardiovascular Risk Factors, Zilebesiran, Shared Decision Making

Episode 394: 402. Cardiovascular Risk Factors, Zilebesiran, Shared Decision Making

https://www.nejm.org/doi/10.1056/NEJMoa2415879?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Key Findings: Classic Risk Factors: The five risk factors examined were hype...

18 Jul 202515min

Episode 393: 404. 3 quick articles you might want to know about (oral semaglutide, tiktok, and GLP1 thyroid cancer)

Episode 393: 404. 3 quick articles you might want to know about (oral semaglutide, tiktok, and GLP1 thyroid cancer)

GLP1 might cause thyroid cancer in mice but the evidence is drastically lacking in humansOral semaglutide is expensive for an NNT of 50 at 4 yrsTiktok videos of skin care are a scam

25 Jun 202512min

Episode 392: 403. 3 Papers, 1 Podcast - One Guideline Changer

Episode 392: 403. 3 Papers, 1 Podcast - One Guideline Changer

https://jamanetwork.com/journals/jama/article-abstract/2834040amiloride is realistically equal to spironolactone for resistant HTNhttps://journals.lww.com/ajg/abstract/2025/05000/higher_rate_of_sponta...

16 Jun 202514min

Episode 391: 402. Functional disability after clinically significant extracranial bleeding: a secondary analysis of ASPREE

Episode 391: 402. Functional disability after clinically significant extracranial bleeding: a secondary analysis of ASPREE

https://www.jthjournal.org/article/S1538-7836(25)00109-6/fulltextAntithrombotic agents, like aspirin and anticoagulants, are essential for treating many cardiovascular conditions. However, a common si...

5 Jun 20257min

Episode 390: 401. Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension

Episode 390: 401. Add-On Treatment With Zilebesiran for Inadequately Controlled Hypertension

https://jamanetwork.com/journals/jama/article-abstract/2834632SummaryThe article examines the effectiveness and safety of zilebesiran, an RNA interference therapeutic agent, when used in combination w...

4 Jun 20258min

Episode 389: 400. CRP, Lipoprotein A, LDL for cardiac risk assessment

Episode 389: 400. CRP, Lipoprotein A, LDL for cardiac risk assessment

https://www.nejm.org/doi/full/10.1056/NEJMoa2405182?query=recirc_Semantic  Key Takeaways Extended Predictive Value of Biomarkers: High-sensitivity C-reactive protein (CRP), LDL cholesterol, and lipop...

29 Mai 20259min

Episode 388: 399. Use of albumin-adjusted calcium measurements in clinical practice

Episode 388: 399. Use of albumin-adjusted calcium measurements in clinical practice

Desgagnés N et al. Use of albumin-adjusted calcium measurements in clinical practice. JAMA Netw Open 2025 Jan 21; 8:e2455251. (https://doi.org/10.1001/jamanetworkopen.2024.55251)Overall, total calcium...

27 Mai 20257min

Episode 387: 398. Which is Better, Tirzepatide or Semaglutide?

Episode 387: 398. Which is Better, Tirzepatide or Semaglutide?

https://www.nejm.org/doi/10.1056/NEJMoa2416394At 72 weeks, the mean percentage decrease in weight was significantly greater with tirzepatide than with semaglutide (20% vs. 14%). Gastrointestinal side ...

21 Mai 20258min

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