Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials.
Pubmed ID: 35058294
Journal: Heart (British Cardiac Society)
Publication Date: 01/20/2022
Affiliation: NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
Grants: PG/18/65/33872, FS/19/36/34346
Authors: Lubsen J, Pitt B, Patel A, Rodgers A, Woodward M, Woodward M, Woodward M, Davis BR, Davis BR, Davis BR, Davis BR, Neal B, Collins R, Imai Y, MacMahon S, Ohkubo T, Sundström J, Sundström J, Sundström J, Lindholm LH, Fagard R, Staessen JA, Pfeffer MA, Yusuf S, Wang J, Chalmers J, Chalmers J, Farzadfar F, Farzadfar F, Rahimi K, Rahimi K, Rahimi K, Poulter NR, Asselbergs FW, Cushman WC, Whelton P, Cutler J, Dwyer JP, Dwyer JP, Dwyer JP, Kostis J, Anderson C, Byington RP, Teo K, Holman RR, Zanchetti A, Sever P, Ogihara T, Pepine CJ, Pepine CJ, Gupta AK, Salam A, Salam A, Canoy D, Canoy D, Nazarzadeh M, Nazarzadeh M, Salimi-Khorshidi G, Algra A, Brown M, Bulpitt CJ, Devereaux RB, Estacio R, Fox K, Fukui T, Ishii M, Julius S, Kanno Y, Kjeldsen SE, Kuramoto K, Lanke J, Lewis E, Lievre M, Lueders S, Matsuzaki M, Mehlum MH, Nissen S, Ogawa H, Rakugi H, Remuzzi G, Ruggenenti P, Saruta T, Schrader J, Schrier R, Thijs L, Ueshima K, Umemoto S, Verdecchia P, Wachtell K, Wing L, Yui Y, Beckett NS, Copland E, Copland E, Ramakrishnan R, Ramakrishnan R, Adler A, Brouwers FPJ, Mancia G, Reboldi G, Reid C, Zhang ZY, Baigent C, Brenner BM, de Zeeuw D, Malacco E, Perkovic V, Rothwell P, Turnbull F, Viberti G, Pinho-Gomes AC, Pinho-Gomes AC, Lewis JB, Palmer CR, Suzuk H, Hvan Gilst W
Cite As: Canoy D, Copland E, Nazarzadeh M, Ramakrishnan R, Pinho-Gomes AC, Salam A, Dwyer JP, Farzadfar F, Sundström J, Woodward M, Davis BR, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration. Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials. Heart 2022 Jan 20. Epub 2022 Jan 20.
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- Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
- Hypertension Detection and Follow-Up Program (HDFP)
- Prevention of Events With Angiotensin-Converting Enzyme Inhibitor Therapy (PEACE)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
- Systolic Hypertension in the Elderly Program (SHEP)
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.