Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials.
MetadataShow full item record
BACKGROUND: The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI). METHODS: We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m(2), 25 to <30 kg/m(2), and =30 kg/m(2)) or a continuous variable. FINDINGS: Analyses were based on 135,715 individuals from 22 trials who had 14,353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m(2) higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics. INTERPRETATION: We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean. FUNDING: None.
Showing items related by title, author, creator and subject.
The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: Meta-analysis of randomized trialsCzernichow, S.; Zanchetti, A.; Turnbull, F.; Barzi, F.; Ninomiya, T.; Kengne, A.; Lambers Heerspink, H.; Perkovic, V.; Huxley, Rachel; Arima, H.; Patel, A.; Chalmers, J.; Woodward, M.; MacMahon, S.; Neal, B. (2011)Background: The benefits of reducing blood pressure are well established, but there remains uncertainty about whether the magnitude of the effect varies with the initial blood pressure level. The objective was to compare ...
Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: A randomized controlled trialBondonno, C.; Yang, X.; Croft, K.; Considine, M.; Ward, Natalie; Rich, L.; Puddey, I.; Swinny, E.; Mubarak, A.; Hodgson, J. (2012)Flavonoids and nitrates in fruits and vegetables may protect against cardiovascular disease. Dietary flavonoids and nitrates can augment nitric oxide status via distinct pathways, which may improve endothelial function ...
Truelove, M.; Patel, A.; Bompoint, S.; Brown, A.; Cass, A.; Hillis, G.; Peiris, D.; Rafter, N.; Reid, Christopher; Rodgers, A.; Tonkin, A.; Usherwood, T.; Webster, R.; Kanyini GAP Collaboration (2015)AIMS: Recent trials of cardiovascular polypills in high-risk populations show improvements in use of cardiovascular preventive treatments, compared to usual care. We describe patterns of pill burden in Australian practice, ...