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Antihypertensive Drug Treatment Potential, Expected, and Observed Effects on Stroke and on Coronary Heart Disease

The effects of prolonged differences in diastolic blood pressure (DBP) on the risks of stroke and of coronary heart disease (CHD) were estimated from nine major prospective observational studies involving about 420,000 men and women who were followed up for intervals of 6–25 years. The results indic... Full description

Journal Title: Hypertension (Dallas Tex. 1979), 1989-05, Vol.13 (5 Suppl I), p.I-45-I-50
Main Author: MacMahon, Stephen
Other Authors: Cutler, Jeffrey A , Stamler, Jeramiah
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: American Heart Association, Inc
ID: ISSN: 0194-911X
Link: https://www.ncbi.nlm.nih.gov/pubmed/2490828
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title: Antihypertensive Drug Treatment Potential, Expected, and Observed Effects on Stroke and on Coronary Heart Disease
format: Article
creator:
  • MacMahon, Stephen
  • Cutler, Jeffrey A
  • Stamler, Jeramiah
subjects:
  • Antihypertensive Agents - therapeutic use
  • Blood Pressure - drug effects
  • Cerebrovascular Disorders - epidemiology
  • Cerebrovascular Disorders - mortality
  • Cerebrovascular Disorders - prevention & control
  • Coronary Disease - epidemiology
  • Coronary Disease - mortality
  • Coronary Disease - prevention & control
  • Diastole
  • Follow-Up Studies
  • Humans
  • Hypertension - drug therapy
  • Hypertension - physiopathology
  • Prospective Studies
  • Risk Factors
ispartof: Hypertension (Dallas, Tex. 1979), 1989-05, Vol.13 (5 Suppl I), p.I-45-I-50
description: The effects of prolonged differences in diastolic blood pressure (DBP) on the risks of stroke and of coronary heart disease (CHD) were estimated from nine major prospective observational studies involving about 420,000 men and women who were followed up for intervals of 6–25 years. The results indicate that a prolonged difference of about 6 mm Hg in DBP was associated with approximately 37% fewer strokes and 23% fewer CHD deaths and nonfatal myocardial infarctions. The effects of equivalent reductions in DBP produced by antihypertensive drug treatment but maintained for only a few years have been estimated in several overviews of randomized trials involving a total of 30,000–40,000 patients. The results of the overviews indicate that treatment reduced the risk of stroke by about 40%, suggesting that most or all the long-term potential benefits for stroke due to lower DBP were achieved within about 3 years of beginning treatment. The risks of nonfatal myocardial infarction and CHD death may have been reduced by about 10% among patients allocated to active treatment; the 95% confidence limits for the difference ranged from about zero to about 20%. Whatever the true effect of treatment on CHD, it would appear somewhat less than the difference in risk estimated from the observational studies for a prolonged difference in DBP of the same size. This apparent shortfall in benefit may reflect a long time-course for changes in DBP to have their full effects on CHD, possible adverse side effects of the principal trial treatments, or both.
language: eng
source:
identifier: ISSN: 0194-911X
fulltext: no_fulltext
issn:
  • 0194-911X
  • 1524-4563
url: Link


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descriptionThe effects of prolonged differences in diastolic blood pressure (DBP) on the risks of stroke and of coronary heart disease (CHD) were estimated from nine major prospective observational studies involving about 420,000 men and women who were followed up for intervals of 6–25 years. The results indicate that a prolonged difference of about 6 mm Hg in DBP was associated with approximately 37% fewer strokes and 23% fewer CHD deaths and nonfatal myocardial infarctions. The effects of equivalent reductions in DBP produced by antihypertensive drug treatment but maintained for only a few years have been estimated in several overviews of randomized trials involving a total of 30,000–40,000 patients. The results of the overviews indicate that treatment reduced the risk of stroke by about 40%, suggesting that most or all the long-term potential benefits for stroke due to lower DBP were achieved within about 3 years of beginning treatment. The risks of nonfatal myocardial infarction and CHD death may have been reduced by about 10% among patients allocated to active treatment; the 95% confidence limits for the difference ranged from about zero to about 20%. Whatever the true effect of treatment on CHD, it would appear somewhat less than the difference in risk estimated from the observational studies for a prolonged difference in DBP of the same size. This apparent shortfall in benefit may reflect a long time-course for changes in DBP to have their full effects on CHD, possible adverse side effects of the principal trial treatments, or both.
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subjectAntihypertensive Agents - therapeutic use ; Blood Pressure - drug effects ; Cerebrovascular Disorders - epidemiology ; Cerebrovascular Disorders - mortality ; Cerebrovascular Disorders - prevention & control ; Coronary Disease - epidemiology ; Coronary Disease - mortality ; Coronary Disease - prevention & control ; Diastole ; Follow-Up Studies ; Humans ; Hypertension - drug therapy ; Hypertension - physiopathology ; Prospective Studies ; Risk Factors
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abstractThe effects of prolonged differences in diastolic blood pressure (DBP) on the risks of stroke and of coronary heart disease (CHD) were estimated from nine major prospective observational studies involving about 420,000 men and women who were followed up for intervals of 6–25 years. The results indicate that a prolonged difference of about 6 mm Hg in DBP was associated with approximately 37% fewer strokes and 23% fewer CHD deaths and nonfatal myocardial infarctions. The effects of equivalent reductions in DBP produced by antihypertensive drug treatment but maintained for only a few years have been estimated in several overviews of randomized trials involving a total of 30,000–40,000 patients. The results of the overviews indicate that treatment reduced the risk of stroke by about 40%, suggesting that most or all the long-term potential benefits for stroke due to lower DBP were achieved within about 3 years of beginning treatment. The risks of nonfatal myocardial infarction and CHD death may have been reduced by about 10% among patients allocated to active treatment; the 95% confidence limits for the difference ranged from about zero to about 20%. Whatever the true effect of treatment on CHD, it would appear somewhat less than the difference in risk estimated from the observational studies for a prolonged difference in DBP of the same size. This apparent shortfall in benefit may reflect a long time-course for changes in DBP to have their full effects on CHD, possible adverse side effects of the principal trial treatments, or both.
copUnited States
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pmid2490828
doi10.1161/01.HYP.13.5_Suppl.I45