https://www.mcmasteroptimalaging.org/full-article/es/people-blood-pressure-lowering-drugs-intensive-therapy-reduces-cardiovascular-367
Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435-43.
Review question
In
people who are prescribed drugs to lower blood pressure, does
more-intensive therapy reduce the risk for major cardiovascular events
(e.g., heart attack, heart failure) and stroke compared with
less-intensive therapy?
Background
People
with high blood pressure and some other conditions (e.g., diabetes,
kidney disease) are more likely than many other people to have a major
cardiovascular event. High blood pressure is usually defined as having a
systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more.
Drugs
that lower blood pressure can reduce risk for cardiovascular events.
More-intensive drug therapy can reduce blood pressure more than
less-intensive drug therapy. It may also be better for reducing
cardiovascular events but could have more side effects.
How the review was done
The researchers did a systematic review, searching for studies that were published up to November 2015.
They found 18 randomized controlled trials
with 44,604 adults (average age 41 to 77 years, 37% to 74% men) and 1
randomized controlled trial with 385 children (average age 12 years, 59%
boys).
The key features of the studies were:
- most people had high blood pressure; some had diabetes, chronic kidney disease, or more than one condition that increased risk for cardiovascular events;
- drugs were used to reduce blood pressure to specific levels or by specific amounts;
- more-intensive therapy was compared with less-intensive therapy;
- more-intensive therapy aimed to reduce blood pressure more than less-intensive therapy; and
- people were followed up for at least 6 months (3.8 years on average).
What the researchers found
Compared with less-intensive therapy, more-intensive blood pressure–lowering therapy:
- reduced blood pressure (SBP by 6.8 mm Hg and DBP by 3.5 mm Hg);
- reduced major cardiovascular events and stroke;
- had similar rates of death, heart attack, heart failure, and end-stage kidney disease; and
- had higher rates of severe low blood pressure, which can cause dizziness or fainting, although yearly event rates were low in both groups (0.1% in the lower-intensity group vs 0.3% in the higher-intensity group, with adverse events leading to discontinuation of treatment in 1% for each group).
Conclusion
In people who
are prescribed drugs to lower blood pressure, more-intensive therapy
reduces cardiovascular events and strokes more than less-intensive
therapy.
Table at the link.
No comments:
Post a Comment