Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean

a systematic review of randomized trials

Blood Pressure Lowering Treatment Trialists’ Collaboration

研究成果: ジャーナルへの寄稿記事

3 引用 (Scopus)

抄録

OBJECTIVE: To assess the clinical relevance of regression to the mean for clinical trials and clinical practice. METHODS: MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. RESULTS: Eighty-six trials (349 488 participants), with mean follow-up of 3.7 years, were included. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14% (95% CI 11-17%) and stroke by 18% (15-22%), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the SBP 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP less than 140 mmHg. CONCLUSION: Clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.

元の言語英語
ページ(範囲)16-23
ページ数8
ジャーナルJournal of hypertension
37
発行部数1
DOI
出版物ステータス出版済み - 1 1 2019

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Blood Pressure
Coronary Disease
Stroke
Therapeutics
MEDLINE
Clinical Trials
Hypertension

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

これを引用

Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean : a systematic review of randomized trials. / Blood Pressure Lowering Treatment Trialists’ Collaboration.

:: Journal of hypertension, 巻 37, 番号 1, 01.01.2019, p. 16-23.

研究成果: ジャーナルへの寄稿記事

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title = "Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean: a systematic review of randomized trials",
abstract = "OBJECTIVE: To assess the clinical relevance of regression to the mean for clinical trials and clinical practice. METHODS: MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. RESULTS: Eighty-six trials (349 488 participants), with mean follow-up of 3.7 years, were included. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14{\%} (95{\%} CI 11-17{\%}) and stroke by 18{\%} (15-22{\%}), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the SBP 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP less than 140 mmHg. CONCLUSION: Clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.",
author = "{Blood Pressure Lowering Treatment Trialists’ Collaboration} and Abdul Salam and Emily Atkins and Johan Sundstr{\"o}m and Yoichiro Hirakawa and Dena Ettehad and Connor Emdin and Bruce Neal and Mark Woodward and John Chalmers and Eivind Berge and Salim Yusuf and Kazem Rahimi and Anthony Rodgers",
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T1 - Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean

T2 - a systematic review of randomized trials

AU - Blood Pressure Lowering Treatment Trialists’ Collaboration

AU - Salam, Abdul

AU - Atkins, Emily

AU - Sundström, Johan

AU - Hirakawa, Yoichiro

AU - Ettehad, Dena

AU - Emdin, Connor

AU - Neal, Bruce

AU - Woodward, Mark

AU - Chalmers, John

AU - Berge, Eivind

AU - Yusuf, Salim

AU - Rahimi, Kazem

AU - Rodgers, Anthony

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVE: To assess the clinical relevance of regression to the mean for clinical trials and clinical practice. METHODS: MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. RESULTS: Eighty-six trials (349 488 participants), with mean follow-up of 3.7 years, were included. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14% (95% CI 11-17%) and stroke by 18% (15-22%), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the SBP 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP less than 140 mmHg. CONCLUSION: Clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.

AB - OBJECTIVE: To assess the clinical relevance of regression to the mean for clinical trials and clinical practice. METHODS: MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. RESULTS: Eighty-six trials (349 488 participants), with mean follow-up of 3.7 years, were included. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14% (95% CI 11-17%) and stroke by 18% (15-22%), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the SBP 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP less than 140 mmHg. CONCLUSION: Clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.

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