TY - JOUR
T1 - The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure
T2 - Meta-analysis of randomized trials
AU - Czernichow, Sébastien
AU - Zanchetti, Alberto
AU - Turnbull, Fiona
AU - Barzi, Federica
AU - Ninomiya, Toshiaru
AU - Kengne, André Pascal
AU - Lambers Heerspink, Hiddo J.
AU - Perkovic, Vlado
AU - Huxley, Rachel
AU - Arima, Hisatomi
AU - Patel, Anushka
AU - Chalmers, John
AU - Woodward, Mark
AU - MacMahon, Stephen
AU - Neal, Bruce
PY - 2011/1
Y1 - 2011/1
N2 - Background: The benefits of reducing blood pressure are well established, but there remains uncertainty about whether the magnitude of the effect varies with the initial blood pressure level. The objective was to compare the risk reductions achieved by different blood pressure-lowering regimens among individuals with different baseline blood pressures. Methods: Thirty-two randomized controlled trials were included and seven comparisons between different types of treatments were made. For each comparison, the primary prespecified analysis included calculation of summary estimates of effect using random-effects meta-analysis for major cardiovascular events in four groups defined by baseline SBP (0.17). This finding was broadly consistent for comparisons of different regimens, for DBP categories, and for commonly used blood pressure cut-points. Conclusion: It appears unlikely that the effectiveness of blood pressure-lowering treatments depends substantively upon starting blood pressure level. As the majority of patients in the trials contributing to these overviews had a history of hypertension or were receiving background blood pressure-lowering therapy, the findings suggest that additional blood pressure reduction in hypertensive patients meeting initial blood pressure targets will produce further benefits. More broadly, the data are supportive of the utilization of blood pressure-lowering regimens in high-risk patients with and without hypertension.
AB - Background: The benefits of reducing blood pressure are well established, but there remains uncertainty about whether the magnitude of the effect varies with the initial blood pressure level. The objective was to compare the risk reductions achieved by different blood pressure-lowering regimens among individuals with different baseline blood pressures. Methods: Thirty-two randomized controlled trials were included and seven comparisons between different types of treatments were made. For each comparison, the primary prespecified analysis included calculation of summary estimates of effect using random-effects meta-analysis for major cardiovascular events in four groups defined by baseline SBP (0.17). This finding was broadly consistent for comparisons of different regimens, for DBP categories, and for commonly used blood pressure cut-points. Conclusion: It appears unlikely that the effectiveness of blood pressure-lowering treatments depends substantively upon starting blood pressure level. As the majority of patients in the trials contributing to these overviews had a history of hypertension or were receiving background blood pressure-lowering therapy, the findings suggest that additional blood pressure reduction in hypertensive patients meeting initial blood pressure targets will produce further benefits. More broadly, the data are supportive of the utilization of blood pressure-lowering regimens in high-risk patients with and without hypertension.
KW - blood pressure-lowering drugs
KW - cardiovascular events
KW - metaanalysis
KW - randomized trials
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U2 - 10.1097/HJH.0b013e32834000be
DO - 10.1097/HJH.0b013e32834000be
M3 - Article
C2 - 20881867
AN - SCOPUS:78650841539
VL - 29
SP - 4
EP - 16
JO - Journal of Hypertension
JF - Journal of Hypertension
SN - 0263-6352
IS - 1
ER -