Antihypertensive drug effects according to the pretreatment self-measured home blood pressure : the HOMED-BP study
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVES: To clarify whether or not the antihypertensive drug effect is proportional to the baseline pretreatment self-measured home blood pressure (HBP) in accordance with the law of initial value (Wilder's law).
DESIGN: A post-hoc analysis of a multicentre clinical trial.
SETTING: Outpatients across Japan with mild-to-moderate essential hypertension.
PARTICIPANTS: Among 3518 randomised participants, 2423 who self-measured HBP during the pretreatment drug-free period (10-28 days after starting fixed-dose antihypertensive monotherapy) with a mean 7.0 years follow-up were eligible.
MAIN OUTCOME MEASURES: We analysed individual HBP readings during pretreatment and monotherapy.
RESULTS: The day-to-day HBP during both the pretreatment period and monotherapy period remains almost the same throughout each period; the results were consistent, regardless of the pretreatment HBP. Following monotherapy, the reduction in the HBP increased by 2.2 mm Hg (95% CI: 1.8 to 2.5 mm Hg) per 10 mm Hg pretreatment HBP increase, up to 11.0 mm Hg (95% CI: 9.9 to 12.0 mm Hg) among patients with an HBP ≥165 mm Hg during pretreatment. Among the 1005 patients receiving low-dose monotherapy (defined daily dose: 0.5 units), the reduction peaked at 8.9-9.1 mm Hg in those with pretreatment HBP 155-164 mm Hg and ≥165 mm Hg (p=0.88).
CONCLUSIONS: According to Wilder's law, the HBP reduction due to fixed-dose monotherapy was proportional to the pretreatment HBP without any regression to the mean phenomenon. With low-dose antihypertensive drugs, however, the HBP reduction peaked in patients with a high pretreatment HBP, indicating the need for such patients to receive a sufficient amount of antihypertensive drug medication at the initial treatment.
TRIAL REGISTRATION: UMIN Clinical Trial Registry (http://www.umin.ac.jp/ctr), Unique identifier: C000000137.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:10 |
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| Enthalten in: |
BMJ open - 10(2020), 12 vom: 12. Dez., Seite e040524 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sano, Hikari [VerfasserIn] |
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| Links: |
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| Themen: |
Antihypertensive Agents |
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| Anmerkungen: |
Date Completed 19.05.2021 Date Revised 31.05.2022 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjopen-2020-040524 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318760940 |
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| 100 | 1 | |a Sano, Hikari |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Antihypertensive drug effects according to the pretreatment self-measured home blood pressure |b the HOMED-BP study |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Revised 31.05.2022 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVES: To clarify whether or not the antihypertensive drug effect is proportional to the baseline pretreatment self-measured home blood pressure (HBP) in accordance with the law of initial value (Wilder's law) | ||
| 520 | |a DESIGN: A post-hoc analysis of a multicentre clinical trial | ||
| 520 | |a SETTING: Outpatients across Japan with mild-to-moderate essential hypertension | ||
| 520 | |a PARTICIPANTS: Among 3518 randomised participants, 2423 who self-measured HBP during the pretreatment drug-free period (10-28 days after starting fixed-dose antihypertensive monotherapy) with a mean 7.0 years follow-up were eligible | ||
| 520 | |a MAIN OUTCOME MEASURES: We analysed individual HBP readings during pretreatment and monotherapy | ||
| 520 | |a RESULTS: The day-to-day HBP during both the pretreatment period and monotherapy period remains almost the same throughout each period; the results were consistent, regardless of the pretreatment HBP. Following monotherapy, the reduction in the HBP increased by 2.2 mm Hg (95% CI: 1.8 to 2.5 mm Hg) per 10 mm Hg pretreatment HBP increase, up to 11.0 mm Hg (95% CI: 9.9 to 12.0 mm Hg) among patients with an HBP ≥165 mm Hg during pretreatment. Among the 1005 patients receiving low-dose monotherapy (defined daily dose: 0.5 units), the reduction peaked at 8.9-9.1 mm Hg in those with pretreatment HBP 155-164 mm Hg and ≥165 mm Hg (p=0.88) | ||
| 520 | |a CONCLUSIONS: According to Wilder's law, the HBP reduction due to fixed-dose monotherapy was proportional to the pretreatment HBP without any regression to the mean phenomenon. With low-dose antihypertensive drugs, however, the HBP reduction peaked in patients with a high pretreatment HBP, indicating the need for such patients to receive a sufficient amount of antihypertensive drug medication at the initial treatment | ||
| 520 | |a TRIAL REGISTRATION: UMIN Clinical Trial Registry (http://www.umin.ac.jp/ctr), Unique identifier: C000000137 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a cardiology | |
| 650 | 4 | |a epidemiology | |
| 650 | 4 | |a hypertension | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 700 | 1 | |a Hara, Azusa |e verfasserin |4 aut | |
| 700 | 1 | |a Asayama, Kei |e verfasserin |4 aut | |
| 700 | 1 | |a Miyazaki, Seiko |e verfasserin |4 aut | |
| 700 | 1 | |a Kikuya, Masahiro |e verfasserin |4 aut | |
| 700 | 1 | |a Imai, Yutaka |e verfasserin |4 aut | |
| 700 | 1 | |a Ohkubo, Takayoshi |e verfasserin |4 aut | |
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