Blood-pressure lowering in intermediate-risk persons without cardiovascular disease
BACKGROUND Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS In one comparison from a 2-...
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Institution: | Universidad EIA |
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Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format: | Artículo de revista |
Language: | English |
Published: |
2016-04-26
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Subjects: | |
Online Access: | https://repositorio.udes.edu.co/handle/001/3457 |
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Summary: | BACKGROUND
Antihypertensive therapy reduces the risk of cardiovascular events among high-risk
persons and among those with a systolic blood pressure of 160 mm Hg or higher,
but its role in persons at intermediate risk and with lower blood pressure is unclear.
METHODS
In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive
either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose
of 12.5 mg per day or placebo. The first coprimary outcome was the composite of
death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke;
the second coprimary outcome additionally included resuscitated cardiac arrest,
heart failure, and revascularization. The median follow-up was 5.6 years.
RESULTS
The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg;
the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment
group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo
group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the
second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one
of the three prespecified hypothesis-based subgroups, participants in the subgroup
for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the
active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle
and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes).
CONCLUSIONS
Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at
a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have
cardiovascular disease. (Funded by the Canadian Institutes of Health Research and
AstraZeneca; ClinicalTrials.gov number, NCT00468923.)
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ISSN: | 1533-4406 |