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Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials
OBJECTIVE: Evidence from randomised trials of pharmacological treatments on long-term blood pressure (BP) reduction is limited. We investigated the antihypertensive drug effects on BP over time and across different participant characteristics. METHODS: We conducted an individual patient-level data m...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340038/ https://www.ncbi.nlm.nih.gov/pubmed/35058294 http://dx.doi.org/10.1136/heartjnl-2021-320171 |
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author | Canoy, Dexter Copland, Emma Nazarzadeh, Milad Ramakrishnan, Rema Pinho-Gomes, Ana-Catarina Salam, Abdul Dwyer, Jamie P Farzadfar, Farshad Sundström, Johan Woodward, Mark Davis, Barry R Rahimi, Kazem |
author_facet | Canoy, Dexter Copland, Emma Nazarzadeh, Milad Ramakrishnan, Rema Pinho-Gomes, Ana-Catarina Salam, Abdul Dwyer, Jamie P Farzadfar, Farshad Sundström, Johan Woodward, Mark Davis, Barry R Rahimi, Kazem |
author_sort | Canoy, Dexter |
collection | PubMed |
description | OBJECTIVE: Evidence from randomised trials of pharmacological treatments on long-term blood pressure (BP) reduction is limited. We investigated the antihypertensive drug effects on BP over time and across different participant characteristics. METHODS: We conducted an individual patient-level data meta-analysis of 52 large-scale randomised clinical trials in the Blood Pressure Lowering Treatment Trialists’ Collaboration using mixed models to examine treatment effects on BP over 4 years of mean follow-up. RESULTS: There were 363 684 participants (42% women), with baseline mean age=65 years and mean systolic/diastolic BP=152/87 mm Hg, and among whom 19% were current smokers, 49% had cardiovascular disease, 28% had diabetes and 69% were taking antihypertensive treatment at baseline. Drugs were effective in lowering BP showing maximal effect after 12 months and gradually attenuating towards later years. Based on measures taken ≥12 months postrandomisation, mean systolic/diastolic BP difference (95% CI) between more and less intense BP-lowering treatment was −11.1 (−11.3 to −10.8)/−5.6 (−5.7 to −5.4) mm Hg; between active treatment and placebo was −5.1 (−5.3 to −5.0)/−2.3 (−2.4 to −2.2) mm Hg; and between active and control arms for drug comparison trials was −1.4 (−1.5 to −1.3)/−0.6 (−0.7 to −0.6) mm Hg. BP reductions were observed across different baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes and prior antihypertensive treatment use. CONCLUSION: These findings suggest that BP-lowering pharmacotherapy is effective in lowering BP, up to 4 years on average, in people with different characteristics. Appropriate treatment strategies are needed to sustain substantive long-term BP reductions. |
format | Online Article Text |
id | pubmed-9340038 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-93400382022-08-16 Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials Canoy, Dexter Copland, Emma Nazarzadeh, Milad Ramakrishnan, Rema Pinho-Gomes, Ana-Catarina Salam, Abdul Dwyer, Jamie P Farzadfar, Farshad Sundström, Johan Woodward, Mark Davis, Barry R Rahimi, Kazem Heart Cardiac Risk Factors and Prevention OBJECTIVE: Evidence from randomised trials of pharmacological treatments on long-term blood pressure (BP) reduction is limited. We investigated the antihypertensive drug effects on BP over time and across different participant characteristics. METHODS: We conducted an individual patient-level data meta-analysis of 52 large-scale randomised clinical trials in the Blood Pressure Lowering Treatment Trialists’ Collaboration using mixed models to examine treatment effects on BP over 4 years of mean follow-up. RESULTS: There were 363 684 participants (42% women), with baseline mean age=65 years and mean systolic/diastolic BP=152/87 mm Hg, and among whom 19% were current smokers, 49% had cardiovascular disease, 28% had diabetes and 69% were taking antihypertensive treatment at baseline. Drugs were effective in lowering BP showing maximal effect after 12 months and gradually attenuating towards later years. Based on measures taken ≥12 months postrandomisation, mean systolic/diastolic BP difference (95% CI) between more and less intense BP-lowering treatment was −11.1 (−11.3 to −10.8)/−5.6 (−5.7 to −5.4) mm Hg; between active treatment and placebo was −5.1 (−5.3 to −5.0)/−2.3 (−2.4 to −2.2) mm Hg; and between active and control arms for drug comparison trials was −1.4 (−1.5 to −1.3)/−0.6 (−0.7 to −0.6) mm Hg. BP reductions were observed across different baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes and prior antihypertensive treatment use. CONCLUSION: These findings suggest that BP-lowering pharmacotherapy is effective in lowering BP, up to 4 years on average, in people with different characteristics. Appropriate treatment strategies are needed to sustain substantive long-term BP reductions. BMJ Publishing Group 2022-08 2022-01-20 /pmc/articles/PMC9340038/ /pubmed/35058294 http://dx.doi.org/10.1136/heartjnl-2021-320171 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Cardiac Risk Factors and Prevention Canoy, Dexter Copland, Emma Nazarzadeh, Milad Ramakrishnan, Rema Pinho-Gomes, Ana-Catarina Salam, Abdul Dwyer, Jamie P Farzadfar, Farshad Sundström, Johan Woodward, Mark Davis, Barry R Rahimi, Kazem Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
title | Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
title_full | Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
title_fullStr | Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
title_full_unstemmed | Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
title_short | Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
title_sort | antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials |
topic | Cardiac Risk Factors and Prevention |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340038/ https://www.ncbi.nlm.nih.gov/pubmed/35058294 http://dx.doi.org/10.1136/heartjnl-2021-320171 |
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