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Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data

Summary Background We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering... Full description

Journal Title: The Lancet (British edition) 2014-08-16, Vol.384 (9943), p.591-598
Main Author: Sundström, Johan
Other Authors: Arima, Hisatomi , Woodward, Mark , Jackson, Rod , Karmali, Kunal , Lloyd-Jones, Donald , Baigent, Colin , Emberson, Jonathan , Rahimi, Kazem , MacMahon, Stephen , Patel, Anushka , Perkovic, Vlado , Turnbull, Fiona , Neal, Bruce
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data
format: Article
creator:
  • Sundström, Johan
  • Arima, Hisatomi
  • Woodward, Mark
  • Jackson, Rod
  • Karmali, Kunal
  • Lloyd-Jones, Donald
  • Baigent, Colin
  • Emberson, Jonathan
  • Rahimi, Kazem
  • MacMahon, Stephen
  • Patel, Anushka
  • Perkovic, Vlado
  • Turnbull, Fiona
  • Neal, Bruce
subjects:
  • Anticholesteremic agents
  • Antihypertensive Agents
  • Antihypertensive Agents - therapeutic use
  • Antihypertensive drugs
  • Biological and medical sciences
  • Blood Pressure
  • Blood Pressure - drug effects
  • Cardiovascular disease
  • Cardiovascular Diseases
  • Cardiovascular Diseases - prevention & control
  • Cholesterol
  • Clinical Medicine
  • Decision Making
  • Drug therapy
  • Endocrinology and Diabetes
  • Endokrinologi och diabetes
  • General aspects
  • Geriatrics
  • Geriatrik
  • Health aspects
  • Heart attack
  • Heart attacks
  • Humans
  • Hypertension
  • Hypertension - drug therapy
  • Internal Medicine
  • Klinisk medicin
  • Medical and Health Sciences
  • Medical research
  • Medical sciences
  • Medicin och hälsovetenskap
  • Medicine, Experimental
  • Risk Assessment
  • Risk Factors
  • Studies
  • Systematic review
  • Usage
ispartof: The Lancet (British edition), 2014-08-16, Vol.384 (9943), p.591-598
description: Summary Background We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy. Methods This meta-analysis included individual participant data from trials that randomly assigned patients to either blood pressure-lowering drugs or placebo, or to more intensive or less intensive blood pressure-lowering regimens. The primary outcome was total major cardiovascular events, consisting of stroke, heart attack, heart failure, or cardiovascular death. Participants were separated into four categories of baseline 5-year major cardiovascular risk using a risk prediction equation developed from the placebo groups of the included trials (21%). Findings 11 trials and 26 randomised groups met the inclusion criteria, and included 67 475 individuals, of whom 51 917 had available data for the calculation of the risk equations. 4167 (8%) had a cardiovascular event during a median of 4·0 years (IQR 3·4–4·4) of follow-up. The mean estimated baseline levels of 5-year cardiovascular risk for each of the four risk groups were 6·0% (SD 2·0), 12·1% (1·5), 17·7% (1·7), and 26·8% (5·4). In each consecutive higher risk group, blood pressure-lowering treatment reduced the risk of cardiovascular events relatively by 18% (95% CI 7–27), 15% (4–25), 13% (2–22), and 15% (5–24), respectively (p=0·30 for trend). However, in absolute terms, treating 1000 patients in each group with blood pressure-lowering treatment for 5 years would prevent 14 (95% CI 8–21), 20 (8–31), 24 (8–40), and 38 (16–61) cardiovascular events, respectively (p=0·04 for trend). Interpretation Lowering blood pressure provides similar relative protection at all levels of baseline cardiovascular risk, but progressively greater absolute risk reductions as baseline risk increases. These results support the use of predicted baseline cardiovascular disease risk equations to inform blood pressure-lowering treatment decisions. Funding None.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
url: Link


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titleBlood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data
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creatorSundström, Johan ; Arima, Hisatomi ; Woodward, Mark ; Jackson, Rod ; Karmali, Kunal ; Lloyd-Jones, Donald ; Baigent, Colin ; Emberson, Jonathan ; Rahimi, Kazem ; MacMahon, Stephen ; Patel, Anushka ; Perkovic, Vlado ; Turnbull, Fiona ; Neal, Bruce
creatorcontribSundström, Johan ; Arima, Hisatomi ; Woodward, Mark ; Jackson, Rod ; Karmali, Kunal ; Lloyd-Jones, Donald ; Baigent, Colin ; Emberson, Jonathan ; Rahimi, Kazem ; MacMahon, Stephen ; Patel, Anushka ; Perkovic, Vlado ; Turnbull, Fiona ; Neal, Bruce ; The Blood Pressure Lowering Treatment Trialists' Collaboration ; Blood Pressure Lowering Treatment Trialists' Collaboration
descriptionSummary Background We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy. Methods This meta-analysis included individual participant data from trials that randomly assigned patients to either blood pressure-lowering drugs or placebo, or to more intensive or less intensive blood pressure-lowering regimens. The primary outcome was total major cardiovascular events, consisting of stroke, heart attack, heart failure, or cardiovascular death. Participants were separated into four categories of baseline 5-year major cardiovascular risk using a risk prediction equation developed from the placebo groups of the included trials (<11%, 11–15%, 15–21%, >21%). Findings 11 trials and 26 randomised groups met the inclusion criteria, and included 67 475 individuals, of whom 51 917 had available data for the calculation of the risk equations. 4167 (8%) had a cardiovascular event during a median of 4·0 years (IQR 3·4–4·4) of follow-up. The mean estimated baseline levels of 5-year cardiovascular risk for each of the four risk groups were 6·0% (SD 2·0), 12·1% (1·5), 17·7% (1·7), and 26·8% (5·4). In each consecutive higher risk group, blood pressure-lowering treatment reduced the risk of cardiovascular events relatively by 18% (95% CI 7–27), 15% (4–25), 13% (2–22), and 15% (5–24), respectively (p=0·30 for trend). However, in absolute terms, treating 1000 patients in each group with blood pressure-lowering treatment for 5 years would prevent 14 (95% CI 8–21), 20 (8–31), 24 (8–40), and 38 (16–61) cardiovascular events, respectively (p=0·04 for trend). Interpretation Lowering blood pressure provides similar relative protection at all levels of baseline cardiovascular risk, but progressively greater absolute risk reductions as baseline risk increases. These results support the use of predicted baseline cardiovascular disease risk equations to inform blood pressure-lowering treatment decisions. Funding None.
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subjectAnticholesteremic agents ; Antihypertensive Agents ; Antihypertensive Agents - therapeutic use ; Antihypertensive drugs ; Biological and medical sciences ; Blood Pressure ; Blood Pressure - drug effects ; Cardiovascular disease ; Cardiovascular Diseases ; Cardiovascular Diseases - prevention & control ; Cholesterol ; Clinical Medicine ; Decision Making ; Drug therapy ; Endocrinology and Diabetes ; Endokrinologi och diabetes ; General aspects ; Geriatrics ; Geriatrik ; Health aspects ; Heart attack ; Heart attacks ; Humans ; Hypertension ; Hypertension - drug therapy ; Internal Medicine ; Klinisk medicin ; Medical and Health Sciences ; Medical research ; Medical sciences ; Medicin och hälsovetenskap ; Medicine, Experimental ; Risk Assessment ; Risk Factors ; Studies ; Systematic review ; Usage
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descriptionSummary Background We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy. Methods This meta-analysis included individual participant data from trials that randomly assigned patients to either blood pressure-lowering drugs or placebo, or to more intensive or less intensive blood pressure-lowering regimens. The primary outcome was total major cardiovascular events, consisting of stroke, heart attack, heart failure, or cardiovascular death. Participants were separated into four categories of baseline 5-year major cardiovascular risk using a risk prediction equation developed from the placebo groups of the included trials (<11%, 11–15%, 15–21%, >21%). Findings 11 trials and 26 randomised groups met the inclusion criteria, and included 67 475 individuals, of whom 51 917 had available data for the calculation of the risk equations. 4167 (8%) had a cardiovascular event during a median of 4·0 years (IQR 3·4–4·4) of follow-up. The mean estimated baseline levels of 5-year cardiovascular risk for each of the four risk groups were 6·0% (SD 2·0), 12·1% (1·5), 17·7% (1·7), and 26·8% (5·4). In each consecutive higher risk group, blood pressure-lowering treatment reduced the risk of cardiovascular events relatively by 18% (95% CI 7–27), 15% (4–25), 13% (2–22), and 15% (5–24), respectively (p=0·30 for trend). However, in absolute terms, treating 1000 patients in each group with blood pressure-lowering treatment for 5 years would prevent 14 (95% CI 8–21), 20 (8–31), 24 (8–40), and 38 (16–61) cardiovascular events, respectively (p=0·04 for trend). Interpretation Lowering blood pressure provides similar relative protection at all levels of baseline cardiovascular risk, but progressively greater absolute risk reductions as baseline risk increases. These results support the use of predicted baseline cardiovascular disease risk equations to inform blood pressure-lowering treatment decisions. Funding None.
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titleBlood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data
authorSundström, Johan ; Arima, Hisatomi ; Woodward, Mark ; Jackson, Rod ; Karmali, Kunal ; Lloyd-Jones, Donald ; Baigent, Colin ; Emberson, Jonathan ; Rahimi, Kazem ; MacMahon, Stephen ; Patel, Anushka ; Perkovic, Vlado ; Turnbull, Fiona ; Neal, Bruce
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abstractSummary Background We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy. Methods This meta-analysis included individual participant data from trials that randomly assigned patients to either blood pressure-lowering drugs or placebo, or to more intensive or less intensive blood pressure-lowering regimens. The primary outcome was total major cardiovascular events, consisting of stroke, heart attack, heart failure, or cardiovascular death. Participants were separated into four categories of baseline 5-year major cardiovascular risk using a risk prediction equation developed from the placebo groups of the included trials (<11%, 11–15%, 15–21%, >21%). Findings 11 trials and 26 randomised groups met the inclusion criteria, and included 67 475 individuals, of whom 51 917 had available data for the calculation of the risk equations. 4167 (8%) had a cardiovascular event during a median of 4·0 years (IQR 3·4–4·4) of follow-up. The mean estimated baseline levels of 5-year cardiovascular risk for each of the four risk groups were 6·0% (SD 2·0), 12·1% (1·5), 17·7% (1·7), and 26·8% (5·4). In each consecutive higher risk group, blood pressure-lowering treatment reduced the risk of cardiovascular events relatively by 18% (95% CI 7–27), 15% (4–25), 13% (2–22), and 15% (5–24), respectively (p=0·30 for trend). However, in absolute terms, treating 1000 patients in each group with blood pressure-lowering treatment for 5 years would prevent 14 (95% CI 8–21), 20 (8–31), 24 (8–40), and 38 (16–61) cardiovascular events, respectively (p=0·04 for trend). Interpretation Lowering blood pressure provides similar relative protection at all levels of baseline cardiovascular risk, but progressively greater absolute risk reductions as baseline risk increases. These results support the use of predicted baseline cardiovascular disease risk equations to inform blood pressure-lowering treatment decisions. Funding None.
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doi10.1016/S0140-6736(14)61212-5