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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Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators 2019-07-24T15:45:52Z 2019-07-24T15:45:52Z 2016-04-26 12 p. 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.) application/pdf 10.1056/NEJMoa1600175 1533-4406 0028-4793 https://repositorio.udes.edu.co/handle/001/3457 eng New England Journal of Medicine Derechos Reservados - New England Journal of Medicine, 2016 info:eu-repo/semantics/openAccess Atribución-NoComercial 4.0 Internacional (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/ https://www.researchgate.net/publication/299592776_Blood-Pressure_Lowering_in_Intermediate-Risk_Persons_without_Cardiovascular_Disease/link/59d8ac87aca272e60966b4a5/download Blood pressure Intermediate risk Cardiovascular disease Blood-pressure lowering in intermediate-risk persons without cardiovascular disease Artículo de revista http://purl.org/coar/resource_type/c_6501 Text info:eu-repo/semantics/article http://purl.org/redcol/resource_type/ART info:eu-repo/semantics/publishedVersion Publication http://purl.org/coar/access_right/c_abf2 http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| institution |
Universidad EIA |
| collection |
d_repositorio.udes.edu.co-DSPACE |
| title |
Blood-pressure lowering in intermediate-risk persons without cardiovascular disease |
| spellingShingle |
Blood-pressure lowering in intermediate-risk persons without cardiovascular disease Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators Blood pressure Intermediate risk Cardiovascular disease |
| title_short |
Blood-pressure lowering in intermediate-risk persons without cardiovascular disease |
| title_full |
Blood-pressure lowering in intermediate-risk persons without cardiovascular disease |
| title_fullStr |
Blood-pressure lowering in intermediate-risk persons without cardiovascular disease |
| title_full_unstemmed |
Blood-pressure lowering in intermediate-risk persons without cardiovascular disease |
| title_sort |
blood-pressure lowering in intermediate-risk persons without cardiovascular disease |
| author |
Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators |
| author_facet |
Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators Lonn, Eva Bosch, Jackie Lopez-Jaramillo, Patricio Zhu, Jun Liu, Lisheng Pais, Prem Diaz, Rafael Xavier, Denis Sliwa, Karen Dans, Antonio Avezum, Alvaro Leopoldo S., Piegas Keltai, Katalin Keltai, Matyas Chazova, Irina Peters, Ron J.G. Held, Claes Yusoff, Khalid Lewis, Basil S. Jansky, Petr Parkhomenko, Alexander Khunti, Kamlesh Toff, William D. Reid, Christopher M. Varigos, John Leiter, Lawrence A. Molina, Dora I. McKelvie, Robert Pogue, Janice Wilkinson, Joanne Jung, Hyejung Dagenais, Gilles Yusuf, Salim HOPE-3 Investigators |
| building |
Repositorio digital |
| topic |
Blood pressure Intermediate risk Cardiovascular disease |
| topic_facet |
Blood pressure Intermediate risk Cardiovascular disease |
| publishDate |
2016-04-26 |
| language |
English |
| format |
Artículo de revista |
| description |
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.)
|
| issn |
1533-4406 |
| url |
https://repositorio.udes.edu.co/handle/001/3457 |
| url_str_mv |
https://repositorio.udes.edu.co/handle/001/3457 |
| _version_ |
1763049749046362112 |
| score |
11.2563715 |
