Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis

作者：Kazem Rahimi, Zeinab Bidel, Milad Nazarzadeh, Emma Copland, Dexter Canoy, Rema Ramakrishnan, Ana‐Catarina Pinho‐Gomes, Mark Woodward, Amanda Adler, Larry Agodoa, Ale Algra, Folkert W. Asselbergs, Nigel Beckett, Eivind Berge, Henry R. Black, Frank P. Brouwers, Morris J. Brown, Christopher J. Bulpitt, Robert P. Byington, William C. Cushman, Jeffrey A. Cutler, Richard B Devereaux, Jamie P. Dwyer, Ray Estacio, Robert Fagard, Kim Fox, Tsuguya Fukui, Ajay Gupta, Rury R. Holman, Yutaka Imai, Masao Ishii, Stevo Julius, Yoshihiko Kanno, Sverre E. Kjeldsen, John B. Kostis, Kizuku Kuramoto, Jan Lanke, Edmund J. Lewis, Julia B. Lewis, Michel Lièvre, Lars Lindholm, Stephan Lueders, Stephen MacMahon, Giuseppe Mancia, Masunori Matsuzaki, Maria H. Mehlum, Steven Nissen, Hiroshi Ogawa, Toshio Ogihara, Takayoshi Ohkubo, Christopher R. Palmer, Anushka Patel, Marc Allan Pfeffer, Bertram Pitt, Neil R Poulter, Hiromi Rakugi, Gianpaolo Reboldi, Christopher M. Reid, Giuseppe Remuzzi, Piero Ruggenenti, Takao Saruta, Joachim Schrader, Robert W. Schrier, Peter Sever, Peter Sleight, Jan A. Staessen, Hiromichi Suzuki, Lutgarde Thijs, Kenji Ueshima, Seiji Umemoto, Wiek H. van Gilst, Paolo Verdecchia, Kristian Wachtell, Paul K. Whelton, Lindon Wing, Yoshiki Yui, Salim Yusuf, Alberto Zanchetti, Zhen‐Yu Zhang, Craig S. Anderson, Colin Baigent, Barry M. Brenner, Rory Collins, Dick de Zeeuw, Jacobus Lubsen, Ettore Malacco, Bruce Neal, Vlado Perkovic, Anthony Rodgers, Peter M. Rothwell, Gholamreza Salimi-Khorshidi, Johan Sundström, Fiona Turnbull, Giancarlo Viberti, Ji‐Guang Wang, John Chalmers, Koon Teo, Carl J. Pepine, Barry R. Davis · 发表于：The Lancet · 年份：2021 · DOI：10.1016/s0140-6736(21)00590-0 · 被引用次数：1058 · 研究领域：Blood Pressure and Hypertension Studies、Sodium Intake and Health、Lipoproteins and Cardiovascular Health

BACKGROUND: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascu...