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More focus needed on prompt treatment to maintain lower BP in high-risk individuals

07 Dec 2018
The impacts of loosened blood pressure guidelines

Less focus must be given on pretreatment blood pressure (BP) levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients, according to recent study. Focus must be directed instead on prompt, empirical treatment to maintain lower BP for individuals with high BP or high risk.

The investigators searched Medline until February 2018 for randomized trials of BP lowering with over 1,000 patient-years follow-up per group. They estimated baseline mean BP, follow-up mean (usual) BP among patients grouped by 10 mm Hg strata of baseline BP and evaluated the effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels.

A total of 86 trials (n=349,488), with mean follow-up of 3.7 years, met the inclusion criteria. Most mean BP change was caused by regression to the mean rather than treatment.

At high baseline BP levels, much of the fall in BP was due to the downwards regression to the mean, even after rigorous hypertension diagnosis. At low baseline BP levels, upwards regression to the mean led to an increase in BP levels even in treatment groups.

In general, a reduction of 6/3 mm Hg in BP lowered CHD by 14 percent (95 percent CI, 11–17 percent) and stroke by 18 percent (15–22 percent). These treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. There was more evidence available in the SBP 130–129 mm Hg range than in any other range.

“Benefits were apparent in numerous high-risk patient groups with baseline mean SBP <140 mm Hg,” the investigators said.

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Most Read Articles
Pearl Toh, 2 days ago
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
5 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.
Pearl Toh, 07 Dec 2018
Apixaban slashes the risk of recurrent venous thromboembolism (VTE) by 90 percent in cancer patients compared with the low-molecular-weight heparin (LMWH) dalteparin, with no increase in major bleeding risk, according to the ADAM VTE study presented at ASH 2018.
Yesterday
Rates of major bleeding events are similar across cancer patients taking direct oral anticoagulants (DOAC), low-molecular-weight heparin (LMWH) or vitamin K antagonist (VKA), with gastrointestinal bleeding being the most frequent event, a recent study has shown. In addition, DOAC and LMWH recorded higher rates of venous thromboembolism than earlier studies.