The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials
Identifieur interne : 006635 ( Main/Exploration ); précédent : 006634; suivant : 006636The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials
Auteurs : Sébastien Czernichow [Australie, France] ; Alberto Zanchetti [Italie] ; Fiona Turnbull [Australie] ; Federica Barzi [Australie] ; Toshiaru Ninomiya [Australie] ; André-Pascal Kengne [Australie] ; Hiddo J. Lambers Heerspink [Pays-Bas] ; Vlado Perkovic [Australie] ; Rachel Huxley [Australie] ; Hisatomi Arima [Australie] ; Anushka Patel [Australie] ; John Chalmers [Australie] ; Mark Woodward [Australie] ; Stephen Macmahon [Australie] ; Bruce Neal [Australie]Source :
- Journal of hypertension [ 0263-6352 ] ; 2011.
Descripteurs français
- Pascal (Inist)
English descriptors
Abstract
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 (<140, 140-159, 160-179, and ≥180 mmHg). Results There were 201 566 participants among whom 20079 primary outcome events were observed. There was no evidence of differences in the proportionate risk reductions achieved with different blood pressure-lowering regimens across groups defined according to higher or lower levels of baseline SBP (all P for trend >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.
Affiliations:
- Australie, France, Italie, Pays-Bas
- Groningue (province), Lombardie, Nouvelle-Galles du Sud, Île-de-France
- Bobigny, Groningue, Milan, Sydney
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type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Public Health Department, Hôpital Avicenne and University of Paris 13</s1><s2>Bobigny</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Bobigny</settlement></placeName></affiliation></author><author><name sortKey="Zanchetti, Alberto" sort="Zanchetti, Alberto" uniqKey="Zanchetti A" first="Alberto" last="Zanchetti">Alberto Zanchetti</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>University of Milan and Institute Auxologico Italiano</s1><s2>Milan</s2><s3>ITA</s3><sZ>2 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Turnbull, Fiona" 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Lambers Heerspink</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen</s1><s2>Groningen</s2><s3>NLD</s3><sZ>7 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Perkovic, Vlado" sort="Perkovic, Vlado" uniqKey="Perkovic V" first="Vlado" last="Perkovic">Vlado Perkovic</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Huxley, Rachel" sort="Huxley, Rachel" uniqKey="Huxley R" first="Rachel" last="Huxley">Rachel Huxley</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>The George Institute</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of hypertension</title><title level="j" type="abbreviated">J. hypertens.</title><idno type="ISSN">0263-6352</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of hypertension</title><title level="j" type="abbreviated">J. hypertens.</title><idno type="ISSN">0263-6352</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arterial pressure</term><term>Blood pressure</term><term>Cardiovascular disease</term><term>Hypertension</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pathologie de l'appareil circulatoire</term><term>Pression artérielle</term><term>Pression sanguine</term><term>Hypertension artérielle</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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 (<140, 140-159, 160-179, and ≥180 mmHg). Results There were 201 566 participants among whom 20079 primary outcome events were observed. There was no evidence of differences in the proportionate risk reductions achieved with different blood pressure-lowering regimens across groups defined according to higher or lower levels of baseline SBP (all P for trend >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.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Italie</li><li>Pays-Bas</li></country><region><li>Groningue (province)</li><li>Lombardie</li><li>Nouvelle-Galles du Sud</li><li>Île-de-France</li></region><settlement><li>Bobigny</li><li>Groningue</li><li>Milan</li><li>Sydney</li></settlement></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Czernichow, Sebastien" sort="Czernichow, Sebastien" uniqKey="Czernichow S" first="Sébastien" last="Czernichow">Sébastien Czernichow</name></region><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name><name sortKey="Barzi, Federica" sort="Barzi, Federica" uniqKey="Barzi F" first="Federica" last="Barzi">Federica Barzi</name><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><name sortKey="Huxley, Rachel" sort="Huxley, Rachel" uniqKey="Huxley R" first="Rachel" last="Huxley">Rachel Huxley</name><name sortKey="Kengne, Andre Pascal" sort="Kengne, Andre Pascal" uniqKey="Kengne A" first="André-Pascal" last="Kengne">André-Pascal Kengne</name><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><name sortKey="Ninomiya, Toshiaru" sort="Ninomiya, Toshiaru" uniqKey="Ninomiya T" first="Toshiaru" last="Ninomiya">Toshiaru Ninomiya</name><name sortKey="Patel, Anushka" sort="Patel, Anushka" uniqKey="Patel A" first="Anushka" last="Patel">Anushka Patel</name><name sortKey="Perkovic, Vlado" sort="Perkovic, Vlado" uniqKey="Perkovic V" first="Vlado" last="Perkovic">Vlado Perkovic</name><name sortKey="Turnbull, Fiona" sort="Turnbull, Fiona" uniqKey="Turnbull F" first="Fiona" last="Turnbull">Fiona Turnbull</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></country><country name="France"><region name="Île-de-France"><name sortKey="Czernichow, Sebastien" sort="Czernichow, Sebastien" uniqKey="Czernichow S" first="Sébastien" last="Czernichow">Sébastien Czernichow</name></region></country><country name="Italie"><region name="Lombardie"><name sortKey="Zanchetti, Alberto" sort="Zanchetti, Alberto" uniqKey="Zanchetti A" first="Alberto" last="Zanchetti">Alberto Zanchetti</name></region></country><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="Lambers Heerspink, Hiddo J" sort="Lambers Heerspink, Hiddo J" uniqKey="Lambers Heerspink H" first="Hiddo J." last="Lambers Heerspink">Hiddo J. 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