Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.
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-...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
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2016
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| Online Access: | http://hdl.handle.net/20.500.11937/12214 |
| _version_ | 1848748015839346688 |
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| author | Lonn, E. Bosch, J. López-Jaramillo, P. Zhu, J. Liu, L. Pais, P. Diaz, R. Xavier, D. Sliwa, K. Dans, A. Avezum, A. Piegas, L. Keltai, K. Keltai, M. Chazova, I. Peters, R. Held, C. Yusoff, K. Lewis, B. Jansky, P. Parkhomenko, A. Khunti, K. Toff, W. Reid, Christopher Varigos, J. Leiter, L. Molina, D. McKelvie, R. Pogue, J. Wilkinson, J. Jung, H. Dagenais, G. Yusuf, S. HOPE-3 Investigators |
| author_facet | Lonn, E. Bosch, J. López-Jaramillo, P. Zhu, J. Liu, L. Pais, P. Diaz, R. Xavier, D. Sliwa, K. Dans, A. Avezum, A. Piegas, L. Keltai, K. Keltai, M. Chazova, I. Peters, R. Held, C. Yusoff, K. Lewis, B. Jansky, P. Parkhomenko, A. Khunti, K. Toff, W. Reid, Christopher Varigos, J. Leiter, L. Molina, D. McKelvie, R. Pogue, J. Wilkinson, J. Jung, H. Dagenais, G. Yusuf, S. HOPE-3 Investigators |
| author_sort | Lonn, E. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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; ClinicalTrials.gov number, NCT00468923.). |
| first_indexed | 2025-11-14T06:58:20Z |
| format | Journal Article |
| id | curtin-20.500.11937-12214 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T06:58:20Z |
| publishDate | 2016 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-122142018-03-29T09:06:08Z Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. Lonn, E. Bosch, J. López-Jaramillo, P. Zhu, J. Liu, L. Pais, P. Diaz, R. Xavier, D. Sliwa, K. Dans, A. Avezum, A. Piegas, L. Keltai, K. Keltai, M. Chazova, I. Peters, R. Held, C. Yusoff, K. Lewis, B. Jansky, P. Parkhomenko, A. Khunti, K. Toff, W. Reid, Christopher Varigos, J. Leiter, L. Molina, D. McKelvie, R. Pogue, J. Wilkinson, J. Jung, H. Dagenais, G. Yusuf, S. HOPE-3 Investigators 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; ClinicalTrials.gov number, NCT00468923.). 2016 Journal Article http://hdl.handle.net/20.500.11937/12214 10.1056/NEJMoa1600175 restricted |
| spellingShingle | Lonn, E. Bosch, J. López-Jaramillo, P. Zhu, J. Liu, L. Pais, P. Diaz, R. Xavier, D. Sliwa, K. Dans, A. Avezum, A. Piegas, L. Keltai, K. Keltai, M. Chazova, I. Peters, R. Held, C. Yusoff, K. Lewis, B. Jansky, P. Parkhomenko, A. Khunti, K. Toff, W. Reid, Christopher Varigos, J. Leiter, L. Molina, D. McKelvie, R. Pogue, J. Wilkinson, J. Jung, H. Dagenais, G. Yusuf, S. HOPE-3 Investigators Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. |
| title | Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. |
| title_full | Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. |
| title_fullStr | Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. |
| title_full_unstemmed | Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. |
| title_short | Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. |
| title_sort | blood-pressure lowering in intermediate-risk persons without cardiovascular disease. |
| url | http://hdl.handle.net/20.500.11937/12214 |