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Blood pressure-lowe...
Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure : A meta-analysis of individual participant data
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- Karmali, Kunal N. (author)
- Northwestern Univ, Dept Med, Chicago, IL 60611 USA.
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- Lloyd-Jones, Donald M. (author)
- Northwestern Univ, Dept Med, Chicago, IL 60611 USA.
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- van der Leeuw, Joep (author)
- Univ Med Ctr Utrecht, Dept Vasc Med, Utrecht, Netherlands.
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- Goff, David C., Jr. (author)
- NHLBI, Div Cardiovasc Sci, Bldg 10, Bethesda, MD 20892 USA.
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- Yusuf, Salim (author)
- McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.
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- Zanchetti, Alberto (author)
- Ist Auxol Italiano, Milan, Italy.
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- Glasziou, Paul (author)
- Bond Univ, Ctr Res Evidence Based Practice, Robina, Australia.
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- Jackson, Rodney (author)
- Univ Auckland, Sch Populat Hlth, Fac Med & Hlth Sci, Auckland, New Zealand.
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- Woodward, Mark (author)
- Univ Oxford, George Inst Global Hlth, Oxford, England.;George Inst Global Hlth, Sydney, NSW, Australia.
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- Rodgers, Anthony (author)
- George Inst Global Hlth, Sydney, NSW, Australia.
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- Neal, Bruce C. (author)
- George Inst Global Hlth, Sydney, NSW, Australia.
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- Berge, Eivind (author)
- Oslo Univ Hosp, Dept Cardiol, Oslo, Norway.
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- Teo, Koon (author)
- McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.
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- Davis, Barry R. (author)
- Univ Texas Dallas, Sch Publ Hlth, Dallas, TX USA.
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- Chalmers, John (author)
- George Inst Global Hlth, Sydney, NSW, Australia.
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- Pepine, Carl (author)
- Univ Florida, Div Cardiovasc Med, Gainesville, FL USA.
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- Rahimi, Kazem (author)
- Univ Oxford, George Inst Global Hlth, Oxford, England.
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- Sundström, Johan (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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Northwestern Univ, Dept Med, Chicago, IL 60611 USA Univ Med Ctr Utrecht, Dept Vasc Med, Utrecht, Netherlands. (creator_code:org_t)
- 2018-03-20
- 2018
- English.
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In: PLoS Medicine. - : PUBLIC LIBRARY SCIENCE. - 1549-1277 .- 1549-1676. ; 15:3
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Abstract
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- Background: Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level.Methods and findings: We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013. Trials randomly assigned participants to either blood pressure-lowering drugs versus placebo or more intensive versus less intensive blood pressure-lowering regimens. We estimated 5-y risk of CVD events using a multivariable Weibull model previously developed in this dataset. We compared the two strategies at specific SBP thresholds and across the spectrum of risk and blood pressure levels studied in BPLTTC trials. The primary outcome was number of CVD events avoided per persons treated. We included data from 11 trials (47,872 participants). During a median of 4.0 y of follow-up, 3,566 participants (7.5%) experienced a major cardiovascular event. Areas under the curve comparing the two treatment strategies throughout the range of possible thresholds for CVD risk and SBP demonstrated that, on average, a greater number of CVD events would be avoided for a given number of persons treated with the CVD risk strategy compared with the SBP strategy (area under the curve 0.71 [95% confidence interval (CI) 0.70-0.72] for the CVD risk strategy versus 0.54 [95% CI 0.53-0.55] for the SBP strategy). Compared with treating everyone with SBP >= 150 mmHg, a CVD risk strategy would require treatment of 29% (95% CI 26%-31%) fewer persons to prevent the same number of events or would prevent 16% (95% CI 14%-18%) more events for the same number of persons treated. Compared with treating everyone with SBP >= 140 mmHg, a CVD risk strategy would require treatment of 3.8% (95% CI 12.5% fewer to 7.2% more) fewer persons to prevent the same number of events or would prevent 3.1% (95% CI 1.5%-5.0%) more events for the same number of persons treated, although the former estimate was not statistically significant. In subgroup analyses, the CVD risk strategy did not appear to be more beneficial than the SBP strategy in patients with diabetes mellitus or established CVD.Conclusions: A blood pressure-lowering treatment strategy based on predicted cardiovascular risk is more effective than one based on blood pressure levels alone across a range of thresholds. These results support using cardiovascular risk assessment to guide blood pressure treatment decision-making in moderate- to high-risk individuals, particularly for primary prevention.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Geriatrik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Geriatrics (hsv//eng)
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Karmali, Kunal N ...
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Lloyd-Jones, Don ...
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van der Leeuw, J ...
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Goff, David C., ...
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Yusuf, Salim
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Zanchetti, Alber ...
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show more...
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Glasziou, Paul
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Jackson, Rodney
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Woodward, Mark
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Rodgers, Anthony
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Neal, Bruce C.
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Berge, Eivind
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Teo, Koon
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Davis, Barry R.
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Chalmers, John
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Pepine, Carl
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Rahimi, Kazem
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Sundström, Johan
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show less...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Geriatrics
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PLoS Medicine
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Uppsala University