TY - JOUR
T1 - Effects of blood pressure reduction in mild hypertension
T2 - A systematic review and meta-analysis
AU - Sundström, Johan
AU - Arima, Hisatomi
AU - Jackson, Rod
AU - Turnbull, Fiona
AU - Rahimi, Kazem
AU - Chalmers, John
AU - Woodward, Mark
AU - Neal, Bruce
AU - Blood Pressure Lowering Treatment Trialists’ Collaboration
AU - Agodoa, Lawrence
AU - Estacio, Raymond
AU - Schrier, Robert
AU - Cutler, Jay
AU - Davis, Barry
AU - Wing, Lindon
AU - Poulter, Neil
AU - Sever, Peter
AU - Remuzzi, Giuseppe
AU - Ruggenenti, Piero
AU - Nissen, Steven
AU - Lindholm, Lars
AU - Fukui, Tsuguya
AU - Ogihara, Toshio
AU - Saruta, Takao
AU - Black, Henry
AU - Sleight, Peter
AU - Lièvre, Michel
AU - Suzuki, Hiromichi
AU - Fox, Kim
AU - Lisheng, Liu
AU - Ohkubo, Takayoshi
AU - Imai, Yutaka
AU - Yusuf, Salim
AU - Bulpitt, Christopher
AU - Lewis, Edmund
AU - Brown, Morris
AU - Wang, Jiguang
AU - Pepine, Carl
AU - Yui, Yoshiki
AU - Pfeffer, Marc
AU - Asselbergs, Folkert W.
AU - Byington, Robert
AU - Pitt, Bertram
AU - Brenner, Barry
AU - Remme, Willem J.
AU - de Zeeuw, Dick
AU - Rahman, Mahboob
AU - Viberti, Giancarlo
AU - Teo, Koon
AU - Zanchetti, Alberto
AU - Malacco, Ettore
AU - Mancia, Giuseppe
AU - Staessen, Jan
AU - Fagard, Robert
AU - Holman, Rury
AU - Kostis, John
AU - Lueders, Stephan
AU - Schrader, Joachim
AU - Anderson, Craig
AU - Collins, Rory
AU - MacMahon, Stephen
AU - Rodgers, Anthony
AU - Whelton, Paul
AU - Yusuf, Salim
PY - 2015/2/3
Y1 - 2015/2/3
N2 - Background: Effects of blood pressure reduction in persons with grade 1 hypertension are unclear. Purpose: To investigate whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with grade 1 hypertension. Data Sources: Trials included in the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and trials identified from a previous review and electronic database searches. Study Selection: Patients without cardiovascular disease with blood pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg) who were randomly assigned to an active (antihypertensive drug or more intensive regimen) or control (placebo or less intensive regimen) blood pressure-lowering regimen. Data Extraction: Individual-patient data from BPLTTC trials and aggregate data from other trials were extracted. Risk of bias was assessed for all trials. Data Synthesis: Individual-patient data involved 10 comparisons from trials where most patients had diabetes, and aggregate data involved 3 comparisons from trials of patients without diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74 to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure, 0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to 0.92) for total deaths. Results were similar in secondary analyses. Withdrawal from treatment due to adverse effects was more common in the active groups. Limitation: Blood pressure reductions and numbers of events were small. Conclusion: Blood pressure-lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension.
AB - Background: Effects of blood pressure reduction in persons with grade 1 hypertension are unclear. Purpose: To investigate whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with grade 1 hypertension. Data Sources: Trials included in the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and trials identified from a previous review and electronic database searches. Study Selection: Patients without cardiovascular disease with blood pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg) who were randomly assigned to an active (antihypertensive drug or more intensive regimen) or control (placebo or less intensive regimen) blood pressure-lowering regimen. Data Extraction: Individual-patient data from BPLTTC trials and aggregate data from other trials were extracted. Risk of bias was assessed for all trials. Data Synthesis: Individual-patient data involved 10 comparisons from trials where most patients had diabetes, and aggregate data involved 3 comparisons from trials of patients without diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74 to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure, 0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to 0.92) for total deaths. Results were similar in secondary analyses. Withdrawal from treatment due to adverse effects was more common in the active groups. Limitation: Blood pressure reductions and numbers of events were small. Conclusion: Blood pressure-lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension.
KW - ACE inhibitors
KW - myocardial infarction
KW - stable coronary artery disease
UR - http://www.scopus.com/inward/record.url?scp=84922753787&partnerID=8YFLogxK
U2 - 10.7326/M14-0773
DO - 10.7326/M14-0773
M3 - Review article
C2 - 25531552
AN - SCOPUS:84922753787
SN - 0003-4819
VL - 162
SP - 184
EP - 191
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 3
ER -