Title |
Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
|
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Published in |
New England Journal of Medicine, April 2016
|
DOI | 10.1056/nejmoa1600175 |
Pubmed ID | |
Authors |
Eva M Lonn, Jackie Bosch, Patricio López-Jaramillo, Jun Zhu, Lisheng Liu, Prem Pais, Rafael Diaz, Denis Xavier, Karen Sliwa, Antonio Dans, Alvaro Avezum, Leopoldo S Piegas, Katalin Keltai, Matyas Keltai, Irina Chazova, Ron J G Peters, Claes Held, Khalid Yusoff, Basil S Lewis, Petr Jansky, Alexander Parkhomenko, Kamlesh Khunti, William D Toff, Christopher M Reid, John Varigos, Lawrence A Leiter, Dora I Molina, Robert McKelvie, Janice Pogue, Joanne Wilkinson, Hyejung Jung, Gilles Dagenais, Salim Yusuf |
Abstract |
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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Country | Count | As % |
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Spain | 22 | 6% |
Canada | 19 | 5% |
United Kingdom | 14 | 4% |
Mexico | 9 | 2% |
Venezuela, Bolivarian Republic of | 9 | 2% |
Japan | 8 | 2% |
Australia | 8 | 2% |
Brazil | 8 | 2% |
Other | 53 | 14% |
Unknown | 146 | 39% |
Demographic breakdown
Type | Count | As % |
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Practitioners (doctors, other healthcare professionals) | 66 | 18% |
Scientists | 45 | 12% |
Science communicators (journalists, bloggers, editors) | 12 | 3% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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United States | 4 | <1% |
United Kingdom | 4 | <1% |
Italy | 3 | <1% |
Brazil | 3 | <1% |
Canada | 2 | <1% |
Japan | 2 | <1% |
France | 1 | <1% |
Norway | 1 | <1% |
Switzerland | 1 | <1% |
Other | 7 | 1% |
Unknown | 640 | 96% |
Demographic breakdown
Readers by professional status | Count | As % |
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Researcher | 81 | 12% |
Other | 79 | 12% |
Student > Bachelor | 74 | 11% |
Student > Ph. D. Student | 64 | 10% |
Student > Master | 56 | 8% |
Other | 205 | 31% |
Unknown | 109 | 16% |
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Nursing and Health Professions | 35 | 5% |
Pharmacology, Toxicology and Pharmaceutical Science | 27 | 4% |
Agricultural and Biological Sciences | 24 | 4% |
Biochemistry, Genetics and Molecular Biology | 13 | 2% |
Other | 53 | 8% |
Unknown | 149 | 22% |