Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials.
Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials.
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DOI：
10.1136/heartjnl-2021-320171
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发表时间：
2022-07-27
期刊：
影响因子：
5.7
通讯作者：
Rahimi, Kazem
中科院分区：
文献类型：
--
作者：
Canoy, Dexter;Copland, Emma;Nazarzadeh, Milad;Ramakrishnan, Rema;Pinho-Gomes, Ana-Catarina;Salam, Abdul;Dwyer, Jamie P.;Farzadfar, Farshad;Sundstrom, Johan;Woodward, Mark;Davis, Barry R.;Rahimi, Kazem
药物治疗长期降低血压的随机试验证据有限。我们研究了抗高血压药物随时间和不同参与者特征对血压的影响。我们使用混合模型对降血压治疗试验者合作组织中的 52 项大型随机临床试验进行了个体患者水平的数据荟萃分析，以检查 4 年平均随访期间对血压的治疗效果。共有 363684 名参与者（42% 女性），基线平均年龄为 65 岁，平均收缩压/舒张压=152/87mm Hg，其中 19% 为当前吸烟者，49% 患有心血管疾病，28% 患有糖尿病，69% 正在基线时接受抗高血压治疗。药物可有效降低血压，12 个月后效果最大，并在以后几年逐渐减弱。根据随机化后≥12个月采取的措施，强度较大和强度较低的降压治疗之间的平均收缩压/舒张压差异（95% CI）为−11.1（−11.3至−10.8）/−5.6（−5.7至−5.4） mm Hg；积极治疗和安慰剂之间的差异为-5.1（-5.3至-5.0）/-2.3（-2.4至-2.2） mm Hg；药物比较试验的活性组和对照组之间的值为-1.4（-1.5至-1.3）/-0.6（-0.7至-0.6） mm Hg。在不同基线血压值和年龄、性别、心血管疾病和糖尿病史以及既往抗高血压治疗使用情况中观察到血压降低。这些研究结果表明，对于具有不同特征的人来说，降压药物疗法可以有效降低血压，平均长达 4 年。需要适当的治疗策略来维持血压的长期实质性降低。
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. 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. 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. 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.
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