Systolic and Diastolic Blood Pressure Lowering as Determinants of Cardiovascular Outcome
TLDR
It is suggested that antihypertensive drug treatment improves outcome mainly through lowering of systolic blood pressure, and absolute benefit increased with age and with lower ratio of DBP to SBP lowering.Abstract:
Based on individual patient data, we performed a quantitative overview of trials in hypertension to investigate to what extent lowering of systolic blood pressure (SBP) and diastolic blood pressure (DBP) contributed to cardiovascular prevention. We selected trials that tested active antihypertensive drugs against placebo or no treatment. Our analyses included 12,903 young (30 to 49 years of age) patients randomized in 3 trials and 14,324 old (60 to 79 years of age) and 1209 very old (> or =80 years of age) patients enrolled in 8 trials. Antihypertensive treatment reduced SBP/DBP by 8.3/4.6 mm Hg in young patients, by 10.7/4.2 mm Hg in old patients, and by 9.4/3.2 mm Hg in very old patients, respectively, resulting in ratios of DBP to SBP lowering of 0.55, 0.39, and 0.32, respectively (P=0.004 for trend with age). In spite of the differential lowering of SBP and DBP, antihypertensive treatment reduced the risk of all cardiovascular events, stroke and myocardial infarction in the 3 age strata to a similar extent. Absolute benefit increased with age and with lower ratio of DBP to SBP lowering. Furthermore, in patients with a larger-than-median reduction in SBP, active treatment consistently reduced the risk of all outcomes irrespective of the decrease in DBP or the achieved DBP. These findings remained consistent if the achieved DBP averaged <70 mm Hg. In conclusion, our overview suggests that antihypertensive drug treatment improves outcome mainly through lowering of SBP.read more
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Journal ArticleDOI
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Paul K. Whelton,Robert M. Carey,Wilbert S. Aronow,Donald E. Casey,Karen J. Collins,Cheryl Dennison Himmelfarb,Sondra M. DePalma,Samuel S. Gidding,Kenneth Jamerson,Daniel W. Jones,Eric J. MacLaughlin,Paul Muntner,Bruce Ovbiagele,Sidney C. Smith,Crystal C. Spencer,Randall S. Stafford,Sandra J. Taler,Randal J. Thomas,Kim A. Williams,Jeff D. Williamson,Jackson T. Wright +20 more
TL;DR: Since 1980, the American College of Cardiology and American Heart Association have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health.
Journal ArticleDOI
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Paul K. Whelton,Robert M. Carey,Wilbert S. Aronow,Donald E. Casey,Karen J. Collins,Cheryl Dennison Himmelfarb,Sondra M. DePalma,Samuel S. Gidding,Kenneth Jamerson,Daniel W. Jones,Eric J. MacLaughlin,Paul Muntner,Bruce Ovbiagele,Sidney C. Smith,Crystal C. Spencer,Randall S. Stafford,Sandra J. Taler,Randal J. Thomas,Kim A. Williams,Jeff D. Williamson,Jackson T. Wright +20 more
TL;DR: The next generation of scientists and decision-makers will have a greater understanding of what constitutes a credible threat to public health and how to protect them from that threat.
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Meta-analysis of individual participant data: rationale, conduct, and reporting
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Mary J. Roman,Richard B. Devereux,Jorge R. Kizer,Elisa T. Lee,James M. Galloway,Tauqeer Ali,Jason G. Umans,Barbara V. Howard +7 more
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Incidence and Prognosis of Resistant Hypertension in Hypertensive Patients
Stacie L. Daugherty,J. David Powers,David J. Magid,Heather M. Tavel,Frederick A. Masoudi,Karen L. Margolis,Patrick J. O'Connor,Joe V. Selby,P. Michael Ho +8 more
TL;DR: Patients with resistant hypertension had an increased risk of cardiovascular events, which supports the need for greater efforts toward improving hypertension outcomes in this population.
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Journal Article
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
M R Stearne,S L Palmer,M S Hammersley,S L Franklin,R S Spivey,Jonathan C. Levy,C R Tidy,N J Bell,J Steemson,B A Barrow,R Coster,K Waring,J Nolan,E Truscott,N Walravens,L Cook,H Lampard,C Merle,P Parker,J McVittie,I Draisey,L E Murchison,A H E Brunt,M J Williams,D W Pearson,X M P Petrie,M E J Lean,D Walmsley,M J Lyall,E Christie,J Church,E Thomson,A Farrow,J M Stowers,M Stowers,K McHardy,N Patterson,Alex D. Wright,N A Levi,A C I Shearer,R J W Thompson,G Taylor,S Rayton,M Bradbury,A Glover,A Smyth-Osbourne,C Parkes,J Graham,P England,S Gyde,C Eagle,B Chakrabarti,Josh Smith,J Sherwell,E M Kohner,A Dornhurst,M C Doddridge,M Dumskyj,S Walji,P Sharp,M Sleightholm,G Vanterpool,C Rose,G Frost,M Roseblade,S Elliott,S Forrester,Meredith C. Foster,K Myers,R Chapman,J R Hayes,R W Henry,M S Featherston,G P R Archbold,M Copeland,R Harper,I Richardson,S Martin,H A Davison,D R Hadden,L Kennedy,A B Atkinson,A M Culbert,C Hegan,H Tennet,N Webb,I Robinson,J Holmes,P M Bell,D R McCance,J Rutherford,S Nesbitt,A S Spathis,S Hyer,M E Nanson,L M James,J M Tyrell,C Davis,P Strugnell,M Booth,H Petrie,D Clark,B Rice,S Hulland,J L Barron,J S Yudkin,B J Gould,J Singer,A Badenock,M Eckert,K Alibhai,E Marriot,Christopher E. Cox,R Price,M Fernandez,A Ryle,S Clarke,G Wallace,E Mehmed,S MacFarlane,R H Greenwood,J Wilson,M J Denholm,R C Temple,K Whitfield,F Johnson,C Munroe,S Gorick,E Duckworth,M Flatman,S Rainbow,L J Borthwick,D J Wheatcroft,R J Seaman,R A Christie,W Wheatcroft,P Musk,Jennifer White,S McDougal,M Bond,P Raniga,R W Newton,R T Jung,C Roxburgh,B Kilgallon,L Dick,N Waugh,S Kilby,A Ellingford,J Burns,C Fox,M C Holloway,H M Coghill,N Hein,A J Fox,W Cowan,M Richard,K Quested,S J Evans,Richard B Paisey,N P R Brown,A J Tucker,R Paisey,F Garrett,J Hogg,P Park,K Williams,P Harvey,R Wilcocks,S Mason,J. C. Frost,C Warren,P Rocket,L Bower,J M Roland,D J Brown,J Youens,K Stanton-King,H Mungall,W Maddison,D Donnelly,S King,P Griffin,Sidney C. Smith,S Church,Graham Dunn,Andrew D. Wilson,K Palmer,P M Brown,D Humphriss,A J M Davidson,Richard Rose,L Armistead,S Townsend,P Poon,I D A Peacock,N J C Culverwell,M H Charlton,B P S Connolly,J Peacock,J Barrett,J Wain,W Beeston,George L. King,P G Hill,Andrew J.M. Boulton,A M Robertson,Katoulis,A Olukoga,H McDonald,S Kumar,F Abouaesha,B Abuaisha,E A Knowles,S Higgins,J Booker,J Sunter,K Breislin,R Parker,P Raval,J Curwell,H Davenport,G Shawcross,A Prest,J Grey,H Cole,C Sereviratne,R J Young,Tim Dornan,J R Clyne,M Gibson,I O'Connell,L M Wong,S J Wilson,K L Wright,Chris Wallace,D McDowell,A C Burden,E M Sellen,R Gregory,M Roshan,N Vaghela,M Burden,C Sherriff,J Clarke,J Grenfell,Je Tooke,K. M. MacLeod,C Searnark,M Rammell,C Pym,J Stockman,C Yeo,J Piper,L Leighton,Ellen Green,M Hoyle,K Jones,A Hudson,A J James,Angela C. Shore,A Higham,B Martin +262 more
TL;DR: Tight blood pressure control in patients with hypertension and type 2 diabetes achieves a clinically important reduction in the risk of deaths related to diabetes, complications related to Diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.
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Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial
Lennart Hansson,Alberto Zanchetti,S. George Carruthers,Björn Dahlöf,Dag Elmfeldt,Stevo Julius,Joël Ménard,Karl Heinz Rahn,Hans Wedel,Sten Westerling +9 more
TL;DR: Intensive lowering of blood pressure in patients with hypertension was associated with a low rate of cardiovascular events and the potential benefit of a low dose of acetylsalicylic acid in the treatment of hypertension was assessed.
Journal ArticleDOI
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group.
Stearne,S L Palmer,Hammersley,S L Franklin,R S Spivey,Jonathan C. Levy,C R Tidy,N J Bell,J Steemson,B A Barrow,R Coster,K Waring,J Nolan,E Truscott,N Walravens,L Cook,H Lampard,C Merle,P Parker,J McVittie,I Draisey,L E Murchison,A H E Brunt,M J Williams,D W Pearson,X M P Petrie,M E J Lean,D Walmsley,M J Lyall,E Christie,J Church,E Thomson,A Farrow,J M Stowers,M Stowers,K McHardy,N Patterson,Alex D. Wright,N A Levi,Aci Shearer,R J W Thompson,G Taylor,S Rayton,M Bradbury,A Glover,A Smyth-Osbourne,C Parkes,J Graham,P England,S Gyde,C Eagle,B Chakrabarti,Josh Smith,J Sherwell,E M Kohner,A Dornhurst,M C Doddridge,M Dumskyj,S Walji,P Sharp,M Sleightholm,G Vanterpool,C Rose,G Frost,M Roseblade,S Elliott,S Forrester,Meredith C. Foster,K Myers,R Chapman,Hayes,R W Henry,Featherston,Gpr Archbold,M Copeland,R Harper,I Richardson,S Martin,H A Davison,Hadden,L Kennedy,A B Atkinson,A M Culbert,C Hegan,H Tennet,N Webb,I Robinson,J Holmes,P M Bell,McCance,J Rutherford,S Nesbitt,A S Spathis,S Hyer,M E Nanson,L M James,J M Tyrell,C Davis,P Strugnell,M Booth,H Petrie,D Clark,B Rice,S Hulland,J L Barron,J S Yudkin,B J Gould,J Singer,A Badenock,M Eckert,K Alibhai,E Marriot,Christopher E. Cox,R Price,M Fernandez,A Ryle,S Clarke,G Wallace,E Mehmed,S MacFarlane,R H Greenwood,James G. Wilson,M J Denholm,R C Temple,K Whitfield,F Johnson,C Munroe,S Gorick,E Duckworth,M Flatman,S Rainbow,L J Borthwick,D J Wheatcroft,R J Seaman,R A Christie,W Wheatcroft,P Musk,Jennifer White,S McDougal,M Bond,P Raniga,R W Newton,R T Jung,C Roxburgh,B Kilgallon,L Dick,N Waugh,S Kilby,A Ellingford,J Burns,C Fox,M C Holloway,H M Coghill,N Hein,A J Fox,W Cowan,M Richard,K Quested,S J Evans,Richard B Paisey,N P R Brown,A J Tucker,R Paisey,F Garrett,J Hogg,P Park,K Williams,P Harvey,R Wilcocks,S Mason,J. C. Frost,C Warren,P Rocket,L Bower,J M Roland,D J Brown,J Youens,K Stanton-King,H Mungall,W Maddison,D Donnelly,S King,P Griffin,Sidney C. Smith,S Church,Graham Dunn,Andrew D. Wilson,K Palmer,P M Brown,D Humphriss,A J M Davidson,Richard Rose,L Armistead,S Townsend,P Poon,I D A Peacock,N J C Culverwell,M H Charlton,B P S Connolly,J Peacock,J Barrett,J Wain,W Beeston,George L. King,P G Hill,A J M Boulton,A M Robertson,Katoulis,A Olukoga,H McDonald,S Kumar,F Abouaesha,B Abuaisha,E A Knowles,S Higgins,J Booker,J Sunter,K Breislin,R Parker,P Raval,J Curwell,H Davenport,G Shawcross,A Prest,J Grey,H Cole,C Sereviratne,R J Young,Tim Dornan,Clyne,M Gibson,I O'Connell,L M Wong,S J Wilson,K L Wright,Chris Wallace,D McDowell,A C Burden,E M Sellen,R Gregory,M Roshan,N Vaghela,M Burden,C Sherriff,J Clarke,J Grenfell,Je Tooke,K. M. MacLeod,C Searnark,M Rammell,C Pym,J Stockman,C Yeo,J Piper,L Leighton,Ellen Green,M Hoyle,K Jones,A Hudson,A J James,Angela C. Shore,A Higham,B Martin,Uspds Grp +263 more
TL;DR: In this article, the authors compared tight control of blood pressure with less tight control aiming at a blood pressure of <150/85 mm Hg with the use of an angiotensin converting enzyme inhibitor captopril or a beta blocker atenolol as main treatment.
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