J-Shaped Relationship between Blood Pressure and Mortality in Hypertensive Patients: New Insights from a Meta-Analysis of Individual-Patient Data

摘要: BACKGROUND: Population-based longitudinal studies of hypertension have usually shown a continuous and positive relationship between blood pressure mortality. However, several in hypertensive patients receiving treatment described this as J-shaped, with an increased risk for events low pressure. OBJECTIVE: To assess the evidence J-shaped mortality its relation to treatment. DESIGN: Meta-analysis individual-patient data. SETTING: Seven randomized clinical trials from INDANA (INdividual Data ANalysis Antihypertensive intervention) database. PATIENTS: 40 233 persons (mean follow-up, 3.9 years). INTERVENTION: Primarily beta-blockers or thiazide diuretics versus placebo no MEASUREMENTS: Diastolic systolic number cardiovascular, noncardiovascular, all-cause deaths yearly periods follow-up. RESULTS: The analysis included data on 1655 (56% cardiovascular). A diastolic death was observed total cardiovascular treated (nadir, 84 80 mm Hg, respectively) untreated 90 85 respectively). For noncardiovascular deaths, group Hg) negative control group. Similar results were presence wide pulse did not explain these findings. CONCLUSIONS: related antihypertensive specific pressure-related events. Poor health conditions leading probably curve.