Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis
| Title: | Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis |
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| Authors: | Rahimi, Kazem; Bidel, Zeinab; Nazarzadeh, Milad; Copland, Emma; Canoy, Dexter; Wamil, Malgorzata; Majert, Jeannette; McManus, Richard; Adler, Amanda; Agodoa, Larry; Algra, Ale; Asselbergs, Folkert W; Beckett, Nigel S; Berge, Eivind; Black, Henry; Boersma, Eric; Brouwers, Frank P J; Brown, Morris; Brugts, Jasper J; Bulpitt, Christopher J; Byington, Robert P; Cushman, William C; Cutler, Jeffrey; Devereaux, Richard B; Dwyer, Jamie P; Estacio, Ray; Fagard, Robert; Fox, Kim; Fukui, Tsuguya; Gupta, Ajay K; Holman, Rury R; Imai, Yutaka; Ishii, Masao; Julius, Stevo; Kanno, Yoshihiko; Kjeldsen, Sverre E; Kostis, John; Kuramoto, Kizuku; Lanke, Jan; Lewis, Edmund; Lewis, Julia B; Lievre, Michel; Lindholm, Lars H; Lueders, Stephan; MacMahon, Stephen; Mancia, Giuseppe; Matsuzaki, Masunori; Mehlum, Maria H; Nissen, Steven; Ogawa, Hiroshi; Ogihara, Toshio; Ohkubo, Takayoshi; Palmer, Christopher R; Patel, Anushka; Pfeffer, Marc Allan; Pitt, Bertram; Poulter, Neil R; Rakugi, Hiromi; Reboldi, Gianpaolo; Reid, Christopher; Remuzzi, Giuseppe; Ruggenenti, Piero; Saruta, Takao; Schrader, Joachim; Schrier, Robert; Sever, Peter; Sleight, Peter; Staessen, Jan A; Suzuki, Hiromichi; Thijs, Lutgarde; Ueshima, Kenji; Umemoto, Seiji; van Gilst, Wiek H; Verdecchia, Paolo; Wachtell, Kristian; Whelton, Paul; Wing, Lindon; Woodward, Mark; Yui, Yoshiki; Yusuf, Salim; Zanchetti, Alberto; Zhang, Zhen-Yu; Anderson, Craig; Baigent, Colin; Brenner, Barry Morton; Collins, Rory; de Zeeuw, Dick; Lubsen, Jacobus; Malacco, Ettore; Neal, Bruce; Perkovic, Vlado; Rodgers, Anthony; Rothwell, Peter; Salimi-Khorshidi, Gholamreza; Sundström, Johan; Turnbull, Fiona; Viberti, Giancarlo; Wang, Jiguang; Chalmers, John; Davis, Barry R; Pepine, Carl J; Teo, Koon K |
| Contributors: | Rahimi, Kazem; Bidel, Zeinab; Nazarzadeh, Milad; Copland, Emma; Canoy, Dexter; Wamil, Malgorzata; Majert, Jeannette; Mcmanus, Richard; Adler, Amanda; Agodoa, Larry; Algra, Ale; Asselbergs, Folkert W; Beckett, Nigel S; Berge, Eivind; Black, Henry; Boersma, Eric; Brouwers, Frank P J; Brown, Morri; Brugts, Jasper J; Bulpitt, Christopher J; Byington, Robert P; Cushman, William C; Cutler, Jeffrey; Devereaux, Richard B; Dwyer, Jamie P; Estacio, Ray; Fagard, Robert; Fox, Kim; Fukui, Tsuguya; Gupta, Ajay K; Holman, Rury R; Imai, Yutaka; Ishii, Masao; Julius, Stevo; Kanno, Yoshihiko; Kjeldsen, Sverre E; Kostis, John; Kuramoto, Kizuku; Lanke, Jan; Lewis, Edmund; Lewis, Julia B; Lievre, Michel; Lindholm, Lars H; Lueders, Stephan; Macmahon, Stephen; Mancia, Giuseppe; Matsuzaki, Masunori; Mehlum, Maria H; Nissen, Steven; Ogawa, Hiroshi; Ogihara, Toshio; Ohkubo, Takayoshi; Palmer, Christopher R; Patel, Anushka; Pfeffer, Marc Allan; Pitt, Bertram; Poulter, Neil R; Rakugi, Hiromi; Reboldi, Gianpaolo; Reid, Christopher; Remuzzi, Giuseppe; Ruggenenti, Piero; Saruta, Takao; Schrader, Joachim; Schrier, Robert; Sever, Peter; Sleight, Peter; Staessen, Jan A; Suzuki, Hiromichi; Thijs, Lutgarde; Ueshima, Kenji; Umemoto, Seiji; van Gilst, Wiek H; Verdecchia, Paolo; Wachtell, Kristian; Whelton, Paul; Wing, Lindon; Woodward, Mark; Yui, Yoshiki; Yusuf, Salim; Zanchetti, Alberto; Zhang, Zhen-Yu; Anderson, Craig; Baigent, Colin; Brenner, Barry Morton; Collins, Rory; de Zeeuw, Dick; Lubsen, Jacobu; Malacco, Ettore; Neal, Bruce; Perkovic, Vlado; Rodgers, Anthony; Rothwell, Peter; Salimi-Khorshidi, Gholamreza; Sundström, Johan; Turnbull, Fiona; Viberti, Giancarlo; Wang, Jiguang; Chalmers, John; Davis, Barry R |
| Publication Year: | 2021 |
| Collection: | IRIS Università degli Studi di Perugia |
| Description: | Background The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline.Methods We did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (= 85 years) and blood pressure categories (in 10 mm Hg increments from = 170 mm Hg systolic blood pressure and from = 110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring hospital admission.Findings We included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59-75]), with 42 960 (12.0%) participants younger than 55 years, 128 437 (35.8%) aged 55-64 years, 128 506 (35.8%) 65-74 years, 54 016 (15.1%) 75-84 years, and 4788 (1.3%) 85 years and older. The hazard ratios for the risk of major cardiovascular events per 5 mm Hg reduction in systolic blood pressure ... |
| Document Type: | article in journal/newspaper |
| Language: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/34461040; info:eu-repo/semantics/altIdentifier/wos/WOS:000697368600017; volume:398; issue:10305; firstpage:1053; lastpage:1064; numberofpages:12; journal:THE LANCET; https://hdl.handle.net/11391/1553728 |
| DOI: | 10.1016/S0140-6736(21)01921-8 |
| Availability: | https://hdl.handle.net/11391/1553728; https://doi.org/10.1016/S0140-6736(21)01921-8 |
| Accession Number: | edsbas.60800F89 |
| Database: | BASE |