Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease

Abstract

BACKGROUNDAntihypertensive 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. METHODSIn 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. RESULTSThe 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). CONCLUSIONSTherapy 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.) a bs tr ac t

Olmesartan‐based monotherapy vs combination therapy in hypertension: A meta‐analysis based on age and chronic kidney disease status

“…Seven studies were included in the meta‐analysis according to the inclusion criteria previously stated (Figure S1 and Table S1). 10, 17, 18, 19, 20, 21 The full analysis set comprised 5888 patients (OM dual‐combination therapy group, n = 3969; OM monotherapy group, n = 1919). Apparent differences between the baseline characteristics of the OM dual‐combination therapy and OM monotherapy groups were small (Table 1); most patients were men and white with a mean (SD) age of 54.8 (10.7) years, mean (SD) body mass index of 29.7 (5.5) kg/m 2 , and a mean SeBP of 160.2/101.1 mm Hg.…”

Effects of Lipid‐Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE‐3 Trial

“…Details of the HOPE‐3 trial (ClinicalTrials.gov: NCT00239681) have been reported 12, 13, 14, 15. Briefly, HOPE‐3 was an international, double‐blind, randomized, placebo‐controlled trial with a 2×2 factorial design performed in 12 705 participants without CVD but at intermediate cardiovascular risk.…”

Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation

“…74 The combination of these anti-hypertensive therapies with rosuvastatin (10 mg per day) was associated with the greatest reduction in CVR (40%) compared with dual placebo. 75 The benefits associated with this combination were observed in all low density lipoprotein cholesterol (LDL) 74 …”