Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis

作者：Kazem Rahimi, Zeinab Bidel, Milad Nazarzadeh, Emma Copland, Dexter Canoy, Małgorzata Wamil, Jeannette Majert, Richard J. McManus, Amanda Adler, Larry Agodoa, Ale Algra, Folkert W. Asselbergs, Nigel Beckett, Eivind Berge, Henry R. Black, Eric Boersma, Frank P. Brouwers, Morris J. Brown, Jasper J. Brugts, 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, Mark Woodward, 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, Barry R. Davis, Carl J. Pepine, Koon Teo · 发表于：The Lancet · 年份：2021 · DOI：10.1016/s0140-6736(21)01921-8 · 被引用次数：337 · 研究领域：Blood Pressure and Hypertension Studies、Cardiovascular Health and Disease Prevention、Renin-Angiotensin System Studies

Background The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline. Methods We did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (<55 years, 55–64 years, 65–74 years, 75–84 years, and ≥85 years) and blood pressure categories (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg systolic blood pressure and from <70 mm Hg to ≥110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing d...