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<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>Evidence from randomised trials on long-term blood pressure (BP) reduction from pharmacologic treatment is limited. To investigate the effects of antihypertensive drugs on long-term BP change and examine its variation over time and among people with different clinical characteristics</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Individual participant-level data meta-analysis</jats:p></jats:sec><jats:sec><jats:title>Setting and data source</jats:title><jats:p>The Blood Pressure Lowering Treatment Trialists’ Collaboration involving 51 large-scale long-term randomised clinical trials</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>352,744 people (42% women) with mean age of 65 years and mean baseline systolic/diastolic BP of 152/87 mmHg, of whom 18% were current smokers, 50% had cardiovascular disease, 29% had diabetes, and 72% were taking antihypertensive treatment at baseline</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>Pharmacological BP-lowering treatment</jats:p></jats:sec><jats:sec><jats:title>Outcome</jats:title><jats:p>Difference in longitudinal changes in systolic and diastolic BP between randomised treatment arms over an average follow-up of four years</jats:p></jats:sec><jats:sec><jats:title>Result</jats:title><jats:p>Drugs were effective in lowering BP, with the maximum effect becoming apparent after 12-month follow-up and with gradual attenuation towards later years. Based on measures taken ≥12 months post-randomisation, more intense BP-lowering treatment reduced systolic/diastolic BP (95% confidence interval) by −11.2 (−11.4 to −11.0)/−5.6 (−5.8 to −5.5) mmHg than less intense treatment; active treatment by −5.1 (−5.3 to −5.0)/−2.3 (−2.4 to −2.2) mmHg lower than placebo, and active arm by −1.4 (−1.5 to −1.3)/−0.6 (−0.7 to −0.6) mmHg lower than the control arm for drug class comparison trials. BP reductions were consistently observed across a wide range of baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes, and prior antihypertensive treatment use.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Pharmacological agents were effective in lowering long-term BP among individuals with a wide range of characteristics, but the net between-group reductions were modest, which is partly attributable to the intended trial goals.</jats:p></jats:sec>

Original publication

DOI

10.1101/2021.02.19.21252066

Type

Journal article

Publisher

Cold Spring Harbor Laboratory

Publication Date

23/02/2021