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dc.contributor.authorLonn, E.
dc.contributor.authorBosch, J.
dc.contributor.authorLópez-Jaramillo, P.
dc.contributor.authorZhu, J.
dc.contributor.authorLiu, L.
dc.contributor.authorPais, P.
dc.contributor.authorDiaz, R.
dc.contributor.authorXavier, D.
dc.contributor.authorSliwa, K.
dc.contributor.authorDans, A.
dc.contributor.authorAvezum, A.
dc.contributor.authorPiegas, L.
dc.contributor.authorKeltai, K.
dc.contributor.authorKeltai, M.
dc.contributor.authorChazova, I.
dc.contributor.authorPeters, R.
dc.contributor.authorHeld, C.
dc.contributor.authorYusoff, K.
dc.contributor.authorLewis, B.
dc.contributor.authorJansky, P.
dc.contributor.authorParkhomenko, A.
dc.contributor.authorKhunti, K.
dc.contributor.authorToff, W.
dc.contributor.authorReid, Christopher
dc.contributor.authorVarigos, J.
dc.contributor.authorLeiter, L.
dc.contributor.authorMolina, D.
dc.contributor.authorMcKelvie, R.
dc.contributor.authorPogue, J.
dc.contributor.authorWilkinson, J.
dc.contributor.authorJung, H.
dc.contributor.authorDagenais, G.
dc.contributor.authorYusuf, S.
dc.contributor.authorHOPE-3 Investigators
dc.identifier.citationLonn, E. and Bosch, J. and López-Jaramillo, P. and Zhu, J. and Liu, L. and Pais, P. and Diaz, R. et al. 2016. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. The New England Journal of Medicine. 374 (21): pp. 2009-2020.

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; number, NCT00468923.).

dc.titleBlood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.
dc.typeJournal Article
dcterms.source.titleN Engl J Med
curtin.departmentDepartment of Health Policy and Management
curtin.accessStatusFulltext not available

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