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Meta-Analysis
. 2011 Mar 2;305(9):913-22.
doi: 10.1001/jama.2011.250.

Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension: a meta-analysis

Angela M Thompson  1 , Tian Hu, Carrie L Eshelbrenner, Kristi Reynolds, Jiang He, Lydia A Bazzano
Affiliations
Meta-Analysis

Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension: a meta-analysis

Angela M Thompson et al. JAMA. .

Erratum in

  • JAMA. 2011 May 11;305(18):1862

Abstract

Context: Cardiovascular disease (CVD) risk increases beginning at systolic blood pressure levels of 115 mm Hg. Use of antihypertensive medications among patients with a history of CVD or diabetes and without hypertension has been debated.

Objective: To evaluate the effect of antihypertensive treatment on secondary prevention of CVD events and all-cause mortality among persons without clinically defined hypertension.

Data sources: Meta-analysis with systematic search of MEDLINE (1950 to week 3 of January 2011), EMBASE, and the Cochrane Collaboration Central Register of Controlled Clinical Trials and manual examination of references in selected articles and studies.

Study selection: From 874 potentially relevant publications, 25 trials that fulfilled the predetermined inclusion and exclusion criteria were included in the meta-analysis.

Data extraction: Information on participant characteristics, trial design and duration, treatment drug, dose, control, and clinical events were extracted using a standardized protocol. Outcomes included stroke, myocardial infarction (MI), congestive heart failure (CHF), composite CVD outcomes, CVD mortality, and all-cause mortality.

Results: Compared with controls, participants receiving antihypertensive medications had a pooled relative risk of 0.77 (95% confidence interval [CI], 0.61 to 0.98) for stroke, 0.80 (95% CI, 0.69 to 0.93) for MI, 0.71 (95% CI, 0.65 to 0.77) for CHF, 0.85 (95% CI, 0.80 to 0.90) for composite CVD events, 0.83 (95% CI, 0.69 to 0.99) for CVD mortality, and 0.87 (95% CI, 0.80 to 0.95) for all-cause mortality from random-effects models. The corresponding absolute risk reductions per 1000 persons were -7.7 (95% CI, -15.2 to -0.3) for stroke, -13.3 (95% CI, -28.4 to 1.7) for MI, -43.6 (95% CI, -65.2 to -22.0) for CHF events, -27.1 (95% CI, -40.3 to -13.9) for composite CVD events, -15.4 (95% CI, -32.5 to 1.7) for CVD mortality, and -13.7 (95% CI, -24.6 to -2.8) for all-cause mortality. Results did not differ according to trial characteristics or subgroups defined by clinical history.

Conclusions: Among patients with clinical history of CVD but without hypertension, antihypertensive treatment was associated with decreased risk of stroke, CHF, composite CVD events, and all-cause mortality. Additional randomized trial data are necessary to assess these outcomes in patients without CVD clinical recommendations.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1
Figure 1
Selection Process for Studies Included in the Meta-analysis.
Figure 2
Figure 2
Pooled Relative Risks and Absolute Risk Reductions for Fatal or Nonfatal Stroke, Myocardial Infarction, and Congestive Heart Failure and Composite Cardiovascular Disease Outcomes CI indicates confidence interval; CVD, cardiovascular disease; NA, not applicable; NR, not reported. Sizes of data markers indicate the weight of each study in the analysis. For expansions of study names, see Table 1 footnote. aNumber of events could not be calculated from information provided. bNumber of events was estimated from information provided.
Figure 3
Figure 3
Pooled Relative Risks and Absolute Risk Reductions for Cardiovascular and All-Cause Mortality CI indicates confidence interval; CVD, cardiovascular disease; NA, not applicable; NR, not reported. Sizes of data markers indicate the weight of each study in the analysis. For expansions of study names, see Table 1 footnote.
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Comment in

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