Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management
BACKGROUND: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response.
METHODS: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes).
RESULTS: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1).
CONCLUSIONS: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control.
REGISTRATION: URL: https://www.
CLINICALTRIALS: gov; Unique identifier: NCT00145925.
| Errataetall: |
CommentIn: Hypertension. 2023 Jun;80(6):1180-1182. - PMID 37196101 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:80 |
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| Enthalten in: |
Hypertension (Dallas, Tex. : 1979) - 80(2023), 3 vom: 05. März, Seite 608-617 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wang, Nelson [VerfasserIn] |
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| Links: |
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| Themen: |
Antihypertensive Agents |
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| Anmerkungen: |
Date Completed 22.02.2023 Date Revised 19.05.2023 published: Print-Electronic ClinicalTrials.gov: NCT00145925 CommentIn: Hypertension. 2023 Jun;80(6):1180-1182. - PMID 37196101 Citation Status MEDLINE |
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| doi: |
10.1161/HYPERTENSIONAHA.122.20458 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM349809089 |
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| 500 | |a CommentIn: Hypertension. 2023 Jun;80(6):1180-1182. - PMID 37196101 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response | ||
| 520 | |a METHODS: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes) | ||
| 520 | |a RESULTS: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1) | ||
| 520 | |a CONCLUSIONS: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control | ||
| 520 | |a REGISTRATION: URL: https://www | ||
| 520 | |a CLINICALTRIALS: gov; Unique identifier: NCT00145925 | ||
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| 700 | 1 | |a Mancia, Giuseppe |e verfasserin |4 aut | |
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