The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials.

摘要: Background The benefits of reducing blood pressure are well established, but there remains uncertainty about whether the magnitude effect varies with initial level. objective was to compare risk reductions achieved by different pressure-lowering regimens among individuals baseline pressures. Methods Thirty-two randomized controlled trials were included and seven comparisons between types treatments made. For each comparison, primary prespecified analysis calculation summary estimates using random-effects meta-analysis for major cardiovascular events in four groups defined SBP ( = 180 mmHg). Results There 201 566 participants whom 20 079 outcome observed. no evidence differences proportionate across according higher or lower levels (all P trend >0.17). This finding broadly consistent regimens, DBP categories, commonly used cut-points. Conclusion It appears unlikely that effectiveness depends substantively patients contributing these overviews had a history hypertension receiving background therapy, findings suggest additional reduction hypertensive meeting targets will produce further benefits. More broadly, data supportive utilization high-risk without hypertension. J Hypertens 29: 4-16 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.