Johan Sundström, MD, PhD; Hisatomi Arima, MD, PhD; Rod Jackson, MBChB, PhD; Fiona Turnbull, MBChB, MPH (Hons), PhD; Kazem Rahimi, MD; John Chalmers, MD, PhD; Mark Woodward, PhD; Bruce Neal, MBChB, PhD; on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration *
Note: The authors had access to all of the study data, take responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication.
Financial Support: Dr. Sundström was funded by the Swedish Heart-Lung Foundation (grant 20041151), Kjell och Märta Beijers Stiftelse, and the Swedish Research Council (grants 2007-5942 and 2010-1078). Dr. Rahimi was funded by the U.K. National Institute for Health Research (NIHR Oxford Biomedical Research Centre and NIHR Career Development Fellowship). Dr. Neal is supported by an Australian Research Council Future Fellowship, and Dr. Neal and Dr. Woodward are supported by National Health and Medical Research Council of Australia Senior Research Fellowships. This work received partial funding support from a National Health and Medical Research Council of Australia Program Grant. The BPLTTC received funding from the following sources at its initiation: Astra Hässle, Bayer, British Heart Foundation, Bristol-Myers Squibb, Glaxo Wellcome, Hoechst Marion Roussel, Knoll, Merck & Co., Pfizer, Searle, and Institut de Recherches Internationales Servier.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0773.
Requests for Single Reprints: Kazem Rahimi, MD, The George Institute for Global Health, c/o Oxford Martin School, University of Oxford, 34 Broad Street, Oxford OX1 3BD, United Kingdom.
Current Author Addresses: Dr. Sundström: Department of Medical Sciences & Uppsala Clinical Research Center, Uppsala University, SE-75185 Uppsala, Sweden.
Drs. Arima, Turnbull, Chalmers, Woodward, and Neal: The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
Dr. Jackson: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
Dr. Rahimi: The George Institute for Global Health, c/o Oxford Martin School, University of Oxford, 34 Broad Street, Oxford OX1 3BD, United Kingdom.
Author Contributions: Conception and design: J. Sundström, H. Arima, R. Jackson, F. Turnbull, M. Woodward, B. Neal.
Analysis and interpretation of the data: J. Sundström, H. Arima, F. Turnbull, K. Rahimi, J. Chalmers, M. Woodward, B. Neal.
Drafting of the article: J. Sundström, K. Rahimi, B. Neal.
Critical revision of the article for important intellectual content: H. Arima, R. Jackson, F. Turnbull, K. Rahimi, J. Chalmers, M. Woodward, B. Neal.
Final approval of the article: J. Sundström, H. Arima, R. Jackson, F. Turnbull, K. Rahimi, M. Woodward, B. Neal.
Provision of study materials or patients: J. Sundström, K. Rahimi, J. Chalmers.
Statistical expertise: J. Sundström, H. Arima, M. Woodward.
Obtaining of funding: J. Sundström.
Administrative, technical, or logistic support: B. Neal.
Collection and assembly of data: J. Sundström, H. Arima, F. Turnbull, M. Woodward.
Effects of blood pressure reduction in persons with grade 1 hypertension are unclear.
To investigate whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with grade 1 hypertension.
Trials included in the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and trials identified from a previous review and electronic database searches.
Patients without cardiovascular disease with blood pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg) who were randomly assigned to an active (antihypertensive drug or more intensive regimen) or control (placebo or less intensive regimen) blood pressure–lowering regimen.
Individual-patient data from BPLTTC trials and aggregate data from other trials were extracted. Risk of bias was assessed for all trials.
Individual-patient data involved 10 comparisons from trials where most patients had diabetes, and aggregate data involved 3 comparisons from trials of patients without diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74 to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure, 0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to 0.92) for total deaths. Results were similar in secondary analyses. Withdrawal from treatment due to adverse effects was more common in the active groups.
Blood pressure reductions and numbers of events were small.
Blood pressure–lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension.
Swedish Heart-Lung Foundation, Swedish Research Council, Australian Research Council, and National Health and Medical Research Council of Australia.
Sundström J, Arima H, Jackson R, et al, on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of Blood Pressure Reduction in Mild Hypertension: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;162:184–191. doi: https://doi.org/10.7326/M14-0773
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Published: Ann Intern Med. 2015;162(3):184-191.
Cardiology, Coronary Risk Factors, Hypertension, Nephrology.
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