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

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dc.contributor.authorLonn, Eva M
dc.contributor.authorBosch, Jackie
dc.contributor.authorLópez-Jaramillo, Patricio
dc.contributor.authorZhu, Jun
dc.contributor.authorLiu, Lisheng
dc.contributor.authorPais, Prem
dc.contributor.authorDiaz, Rafael
dc.contributor.authorXavier, Denis
dc.contributor.authorSliwa, Karen
dc.contributor.authorDans, Antonio
dc.contributor.authorAvezum, Álvaro
dc.contributor.authorPiegas, Leopoldo S
dc.contributor.authorKeltai, Katalin
dc.contributor.authorKeltai, Matyas
dc.contributor.authorChazova, Irina
dc.contributor.authorPeters, Ron JG
dc.contributor.authorHeld, Claes
dc.contributor.authorYusoff, Khalid
dc.contributor.authorLewis, Basil S
dc.contributor.authorJansky, Petr
dc.contributor.authorParkhomenko, Alexander
dc.contributor.authorKhunti, Kamlesh
dc.contributor.authorToff, William D
dc.contributor.authorReid, Christopher M
dc.contributor.authorVarigos, John
dc.contributor.authorLeiter, Lawrence A
dc.contributor.authorMolina, Dora I
dc.contributor.authorMcKelvie, Robert
dc.contributor.authorPogue, Janice
dc.contributor.authorWilkinson, Joanne
dc.contributor.authorJung, Hyejung
dc.contributor.authorDagenais, Gilles
dc.date.accessioned2021-10-08T07:22:54Z
dc.date.available2021-10-08T07:22:54Z
dc.date.issued2016
dc.description.abstractAntihypertensive 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. 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. 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). 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.)
dc.identifier.apacitationLonn, E. M., Bosch, J., López-Jaramillo, P., Zhu, J., Liu, L., Pais, P., ... Dagenais, G. (2016). Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. <i>The New England Journal of Medicine</i>, 374(21), 2009 - 2020. http://hdl.handle.net/11427/35024en_ZA
dc.identifier.chicagocitationLonn, Eva M, Jackie Bosch, Patricio López-Jaramillo, Jun Zhu, Lisheng Liu, Prem Pais, Rafael Diaz, et al "Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease." <i>The New England Journal of Medicine</i> 374, 21. (2016): 2009 - 2020. http://hdl.handle.net/11427/35024en_ZA
dc.identifier.citationLonn, E.M., Bosch, J., López-Jaramillo, P., Zhu, J., Liu, L., Pais, P., Diaz, R. & Xavier, D. et al. 2016. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. <i>The New England Journal of Medicine.</i> 374(21):2009 - 2020. http://hdl.handle.net/11427/35024en_ZA
dc.identifier.issn0028-4793
dc.identifier.issn1533-4406
dc.identifier.ris TY - Journal Article AU - Lonn, Eva M AU - Bosch, Jackie AU - López-Jaramillo, Patricio AU - Zhu, Jun AU - Liu, Lisheng AU - Pais, Prem AU - Diaz, Rafael AU - Xavier, Denis AU - Sliwa, Karen AU - Dans, Antonio AU - Avezum, Álvaro AU - Piegas, Leopoldo S AU - Keltai, Katalin AU - Keltai, Matyas AU - Chazova, Irina AU - Peters, Ron JG AU - Held, Claes AU - Yusoff, Khalid AU - Lewis, Basil S AU - Jansky, Petr AU - Parkhomenko, Alexander AU - Khunti, Kamlesh AU - Toff, William D AU - Reid, Christopher M AU - Varigos, John AU - Leiter, Lawrence A AU - Molina, Dora I AU - McKelvie, Robert AU - Pogue, Janice AU - Wilkinson, Joanne AU - Jung, Hyejung AU - Dagenais, Gilles AB - 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. 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. 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). 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.) DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 21 J1 - The New England Journal of Medicine LK - https://open.uct.ac.za PY - 2016 SM - 0028-4793 SM - 1533-4406 T1 - Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease TI - Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease UR - http://hdl.handle.net/11427/35024 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35024
dc.identifier.vancouvercitationLonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, et al. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. The New England Journal of Medicine. 2016;374(21):2009 - 2020. http://hdl.handle.net/11427/35024.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceThe New England Journal of Medicine
dc.source.journalissue21
dc.source.journalvolume374
dc.source.pagination2009 - 2020
dc.source.urihttps://dx.doi.org/10.1056/NEJMoa1600175
dc.subject.otherAged
dc.subject.otherAntihypertensive Agents
dc.subject.otherBenzimidazoles
dc.subject.otherBlood Pressure
dc.subject.otherCardiovascular Diseases
dc.subject.otherDouble-Blind Method
dc.subject.otherDrug Therapy, Combination
dc.subject.otherFemale
dc.subject.otherHumans
dc.subject.otherHydrochlorothiazide
dc.subject.otherHypertension
dc.subject.otherHypotension
dc.subject.otherIncidence
dc.subject.otherKaplan-Meier Estimate
dc.subject.otherMale
dc.subject.otherMiddle Aged
dc.subject.otherRisk Factors
dc.subject.otherTetrazoles
dc.subject.otherAntihypertensive Agents
dc.subject.otherBenzimidazoles
dc.subject.otherTetrazoles
dc.subject.otherHydrochlorothiazide
dc.subject.othercandesartan
dc.titleBlood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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