Florent Boutitie, MSc; François Gueyffier, MD; Stuart Pocock, PhD; Robert Fagard, MD; Jean Pierre Boissel, MD; INDANA Project Steering Committee
Acknowledgments: The authors thank John Coope, Jeffrey Cuttler, Tord Ekbom, Lawrence Friedman, Mitchell Perry, Ronald Prineas, and Eleanor Schron for contributing data to the INDANA project.
Grant Support: By the European Community as part of the BIOMED 2 program (contract BMH4-CT98-3291).
Requests for Single Reprints: Florent Boutitie, MSc, EA643 Clinical Pharmacology Unit, Faculte RTH Laennec, BP 8071–69376 Lyon Cedex 08, France; e-mail, firstname.lastname@example.org.
Current Author Addresses: Mr. Boutitie and Drs. Gueyffier and Boissel: EA643 Clinical Pharmacology Unit, Faculte RTH Laennec, BP 8071–69376 Lyon Cedex 08, France.
Dr. Pocock: Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom.
Dr. Fagard: Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, U.Z. Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Author Contributions: Conception and design: F. Boutitie, F. Gueyffier, S. Pocock.
Analysis and interpretation of the data: F. Boutitie, F. Gueyffier, S. Pocock, R. Fagard, J.P. Boissel.
Drafting of the article: F. Boutitie, F. Gueyffier, J.P. Boissel.
Critical revision of the article for important intellectual content: F. Boutitie, F. Gueyffier, S. Pocock, R. Fagard.
Final approval of the article: F. Boutitie, F. Gueyffier, S. Pocock, R. Fagard.
Provision of study materials or patients: F. Gueyffier, R. Fagard.
Statistical expertise: F. Boutitie, S. Pocock.
Obtaining of funding: F. Gueyffier, J.P. Boissel.
Administrative, technical, or logistic support: F. Boutitie.
Collection and assembly of data: F. Gueyffier, R. Fagard, J.P. Boissel.
Boutitie F., Gueyffier F., Pocock S., Fagard R., Boissel J., ; J-Shaped Relationship between Blood Pressure and Mortality in Hypertensive Patients: New Insights from a Meta-Analysis of Individual-Patient Data. Ann Intern Med. 2002;136:438-448. doi: 10.7326/0003-4819-136-6-200203190-00007
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Published: Ann Intern Med. 2002;136(6):438-448.
The benefit of antihypertensive treatments in reducing the risk for cardiovascular events in persons with high blood pressure has been well established (1-3). Despite this evidence, epidemiologic studies have shown that after adjustment for other risk factors, treated hypertensive patients with normalized blood pressure are still at higher risk for cardiovascular diseases than normotensive persons (4). Moreover, in clinical trials the observed risk reduction for coronary events has been smaller than could be expected from the log-linear relationship between blood pressure and risk according to epidemiologic data (5). Clinical trials have reported a 5–to 6–mm Hg difference between the diastolic blood pressures of treatment and control groups; the risk reduction of 14% (95% CI, 4% to 22%) for coronary events contrasts with the 20% to 25% reduction noted in epidemiologic reports. These discrepancies may be related to the existence of a J-shaped relationship between blood pressure and risk, in which treated patients with low blood pressure are at increased risk for coronary events.
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Cardiology, Nephrology, Hypertension, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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