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1. 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

Author

Rahimi, K, Bidel, Z, Nazarzadeh, M, Copland, E, Canoy, D, Wamil, M, Majert, J, Mcmanus, R, Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Boersma, E, Brouwers, F, Brown, M, Brugts, J, Bulpitt, C, Byington, R, Cushman, W, Cutler, J, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Chalmers, J, Davis, B, Pepine, C, Teo, K, Rahimi K., Bidel Z., Nazarzadeh M., Copland E., Canoy D., Wamil M., Majert J., McManus R., Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Boersma E., Brouwers F. P. J., Brown M., Brugts J. J., Bulpitt C. J., Byington R. P., Cushman W. C., Cutler J., Devereaux R. B., Dwyer J. P., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Chalmers J., Davis B. R., Pepine C. J., Teo K. K., Rahimi, K, Bidel, Z, Nazarzadeh, M, Copland, E, Canoy, D, Wamil, M, Majert, J, Mcmanus, R, Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Boersma, E, Brouwers, F, Brown, M, Brugts, J, Bulpitt, C, Byington, R, Cushman, W, Cutler, J, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Chalmers, J, Davis, B, Pepine, C, Teo, K, Rahimi K., Bidel Z., Nazarzadeh M., Copland E., Canoy D., Wamil M., Majert J., McManus R., Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Boersma E., Brouwers F. P. J., Brown M., Brugts J. J., Bulpitt C. J., Byington R. P., Cushman W. C., Cutler J., Devereaux R. B., Dwyer J. P., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Chalmers J., Davis B. R., Pepine C. J., and Teo K. K.

Abstract

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 death or requiring hospital admission. Findings: We included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59–75]), with 42 960 (12·0%) participants younger than 55 years, 128 437 (35·8%) aged 55–64 years, 128 506 (35·8%) 65–74 years, 54 016 (15·1%) 75–84 years, and 4788 (1·3%) 85 years and older. The hazard ratios for the risk of major cardiovascular events per 5 mm Hg

Published
2021

2. 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

Author

Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Brouwers, F, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Cushman, W, Cutler, J, Davis, B, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Brouwers F. P. J., Brown M., Bulpitt C. J., Byington R. P., Chalmers J., Cushman W. C., Cutler J., Davis B. R., Devereaux R. B., Dwyer J., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pepine C. J., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Brouwers, F, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Cushman, W, Cutler, J, Davis, B, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Brouwers F. P. J., Brown M., Bulpitt C. J., Byington R. P., Chalmers J., Cushman W. C., Cutler J., Davis B. R., Devereaux R. B., Dwyer J., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pepine C. J., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., and Wang J.

Abstract

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 cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. Findings: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/8

Published
2021

3. Empowering Children as Agents of Change to Foster Resilience in Community:Implementing “Creative Health” in Primary Schools after the Fukushima Nuclear Disaster

Author

Goto, A., Lloyd Williams, A., Okabe, S., Koyama, Y., Koriyama, C., Murakami, M., Yui, Y., Nollet, K.E., Goto, A., Lloyd Williams, A., Okabe, S., Koyama, Y., Koriyama, C., Murakami, M., Yui, Y., and Nollet, K.E.

Abstract

The “Creative Heath” project, a participatory school activity to foster community resilience, was implemented in Fukushima, Japan, and children’s experiences of the project were assessed both quantitatively and qualitatively. The project consists of three workshops: BODY, FOOD, and ACT, with activities to facilitate students’ scientific and creative thinking, working in teams, presenting, and expressing their opinions. The first two schools participated with 105 students aged 9–11 years old. Before and after each workshop, students were given questionnaires to rate their satisfaction with their own health (BODY), local foods (FOOD), and the community at large (ACT) on a five-level scale, with space to add free comments. Ratings for BODY and FOOD changed significantly, and the proportion of students who increased their rating of an evaluation indicator after each workshop was 25% for BODY, 28% for FOOD, and 25% for ACT. Text analysis of free comments showed that students in the “increased” group appreciated presenting, measuring, learning connections between nutrition and health, and working collaboratively with peers. Children perceived their health and the foods in their community more positively after participating. Moreover, the Creative Health project could be a way to enhance children’s creativity and autonomy as agents of change in the community.

Published
2022

4. Empowering Children as Agents of Change to Foster Resilience in Community : Implementing “Creative Health” in Primary Schools after the Fukushima Nuclear Disaster

Author

Goto, A., Lloyd Williams, A., Okabe, S., Koyama, Y., Koriyama, C., Murakami, M., Yui, Y., Nollet, K.E., Goto, A., Lloyd Williams, A., Okabe, S., Koyama, Y., Koriyama, C., Murakami, M., Yui, Y., and Nollet, K.E.

Abstract

The “Creative Heath” project, a participatory school activity to foster community resilience, was implemented in Fukushima, Japan, and children’s experiences of the project were assessed both quantitatively and qualitatively. The project consists of three workshops: BODY, FOOD, and ACT, with activities to facilitate students’ scientific and creative thinking, working in teams, presenting, and expressing their opinions. The first two schools participated with 105 students aged 9–11 years old. Before and after each workshop, students were given questionnaires to rate their satisfaction with their own health (BODY), local foods (FOOD), and the community at large (ACT) on a five-level scale, with space to add free comments. Ratings for BODY and FOOD changed significantly, and the proportion of students who increased their rating of an evaluation indicator after each workshop was 25% for BODY, 28% for FOOD, and 25% for ACT. Text analysis of free comments showed that students in the “increased” group appreciated presenting, measuring, learning connections between nutrition and health, and working collaboratively with peers. Children perceived their health and the foods in their community more positively after participating. Moreover, the Creative Health project could be a way to enhance children’s creativity and autonomy as agents of change in the community.

Published
2022

5. 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

Author

Adler, A, Agodoa, L, Algra, A, Asselbergs, FW, Beckett, NS, Berge, E, Black, H, Brouwers, FPJ, Brown, M, Bulpitt, CJ, Byington, RP, Chalmers, J, Cushman, WC, Cutler, J, Davis, BR, Devereaux, RB, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, AK, Holman, RR, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, SE, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, JB, Lievre, M, Lindholm, LH, Lueders, S, MacMahon, S, Mancia, G, Matsuzaki, M, Mehlum, MH, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, CR, Patel, A, Pepine, CJ, Pfeffer, MA, Pitt, B, Poulter, NR, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, JA, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, WH, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, ZY, Anderson, C, Baigent, C, Brenner, BM, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundström, J, Turnbull, F, Viberti, G, Wang, J, Adler, A, Agodoa, L, Algra, A, Asselbergs, FW, Beckett, NS, Berge, E, Black, H, Brouwers, FPJ, Brown, M, Bulpitt, CJ, Byington, RP, Chalmers, J, Cushman, WC, Cutler, J, Davis, BR, Devereaux, RB, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, AK, Holman, RR, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, SE, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, JB, Lievre, M, Lindholm, LH, Lueders, S, MacMahon, S, Mancia, G, Matsuzaki, M, Mehlum, MH, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, CR, Patel, A, Pepine, CJ, Pfeffer, MA, Pitt, B, Poulter, NR, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, JA, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, WH, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, ZY, Anderson, C, Baigent, C, Brenner, BM, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundström, J, Turnbull, F, Viberti, G, and Wang, J

Abstract

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 cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. Findings: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 m

Published
2021

6. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: A meta-analysis of randomised trials

Author

Agodoa, L, Estacio, R, Schrier, R, Lubsen, J, Chalmers, J, Cutler, J, Davis, B, Wing, L, Poulter, N, Sever, P, Remuzzi, G, Ruggenenti, P, Nissen, S, Lindholm, L, Fukui, T, Ogihara, T, Saruta, T, Black, H, Sleight, P, Lievre, M, Suzuki, H, Fox, K, Lisheng, L, Ohkubo, T, Imai, Y, Yusuf, S, Bulpitt, C, Lewis, E, Brown, M, Palmer, C, Wang, J, Pepine, C, Ishii, M, Yui, Y, Kuramoto, K, Pfeff Er, M, Asselbergs, F, Van Gilst, W, Byington, B, Pitt, B, Brenner, B, Remme, W, De Zeeuw, D, Rahman, M, Viberti, G, Teo, K, Zanchetti, A, Malacco, E, Mancia, G, Staessen, J, Fagard, R, Holman, R, Hansson, L, Kostis, J, Kanno, Y, Lueders, S, Matsuzaki, M, Poole-Wilson, P, Schrader, J, Rahimi, K, Anderson, C, Chapman, N, Collins, R, Macmahon, S, Neal, B, Rodgers, A, Whelton, P, Woodward, M, Agodoa L., Estacio R., Schrier R., Lubsen J., Chalmers J., Cutler J., Davis B., Wing L., Poulter N. R., Sever P., Remuzzi G., Ruggenenti P., Nissen S., Lindholm L. H., Fukui T., Ogihara T., Saruta T., Black H., Sleight P., Lievre M., Suzuki H., Fox K., Lisheng L., Ohkubo T., Imai Y., Yusuf S., Bulpitt C. J., Lewis E., Brown M., Palmer C., Wang J., Pepine C., Ishii M., Yui Y., Kuramoto K., Pfeff Er M., Asselbergs F. W., Van Gilst W. H., Byington B., Pitt B., Brenner B., Remme W. J., De Zeeuw D., Rahman M., Viberti G., Teo K., Zanchetti A., Malacco E., Mancia G., Staessen J., Fagard R., Holman R., Hansson L., Kostis J., Kanno Y., Lueders S., Matsuzaki M., Poole-Wilson P., Schrader J., Rahimi K., Anderson C., Chapman N., Collins R., MacMahon S., Neal B., Rodgers A., Whelton P., Woodward M., Agodoa, L, Estacio, R, Schrier, R, Lubsen, J, Chalmers, J, Cutler, J, Davis, B, Wing, L, Poulter, N, Sever, P, Remuzzi, G, Ruggenenti, P, Nissen, S, Lindholm, L, Fukui, T, Ogihara, T, Saruta, T, Black, H, Sleight, P, Lievre, M, Suzuki, H, Fox, K, Lisheng, L, Ohkubo, T, Imai, Y, Yusuf, S, Bulpitt, C, Lewis, E, Brown, M, Palmer, C, Wang, J, Pepine, C, Ishii, M, Yui, Y, Kuramoto, K, Pfeff Er, M, Asselbergs, F, Van Gilst, W, Byington, B, Pitt, B, Brenner, B, Remme, W, De Zeeuw, D, Rahman, M, Viberti, G, Teo, K, Zanchetti, A, Malacco, E, Mancia, G, Staessen, J, Fagard, R, Holman, R, Hansson, L, Kostis, J, Kanno, Y, Lueders, S, Matsuzaki, M, Poole-Wilson, P, Schrader, J, Rahimi, K, Anderson, C, Chapman, N, Collins, R, Macmahon, S, Neal, B, Rodgers, A, Whelton, P, Woodward, M, Agodoa L., Estacio R., Schrier R., Lubsen J., Chalmers J., Cutler J., Davis B., Wing L., Poulter N. R., Sever P., Remuzzi G., Ruggenenti P., Nissen S., Lindholm L. H., Fukui T., Ogihara T., Saruta T., Black H., Sleight P., Lievre M., Suzuki H., Fox K., Lisheng L., Ohkubo T., Imai Y., Yusuf S., Bulpitt C. J., Lewis E., Brown M., Palmer C., Wang J., Pepine C., Ishii M., Yui Y., Kuramoto K., Pfeff Er M., Asselbergs F. W., Van Gilst W. H., Byington B., Pitt B., Brenner B., Remme W. J., De Zeeuw D., Rahman M., Viberti G., Teo K., Zanchetti A., Malacco E., Mancia G., Staessen J., Fagard R., Holman R., Hansson L., Kostis J., Kanno Y., Lueders S., Matsuzaki M., Poole-Wilson P., Schrader J., Rahimi K., Anderson C., Chapman N., Collins R., MacMahon S., Neal B., Rodgers A., Whelton P., and Woodward M.

Abstract

Summary Background The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI). Methods We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m2, 25 to <30 kg/m2, and ≥30 kg/m2) or a continuous variable. Findings Analyses were based on 135 715 individuals from 22 trials who had 14 353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m2 higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics. Interpretation We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean. Funding None.

Published
2015

7. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index : A meta-analysis of randomised trials

Author

Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., Woodward, M., Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., and Woodward, M.

Published
2015

8. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index : A meta-analysis of randomised trials

Author

Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., Woodward, M., Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., and Woodward, M.

Published
2015

9. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index : A meta-analysis of randomised trials

Author

Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., Woodward, M., Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., and Woodward, M.

Published
2015

10. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: A meta-analysis of randomised trials

Author

Cardiologie, Circulatory Health, Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., Woodward, M., Cardiologie, Circulatory Health, Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., and Woodward, M.

Published
2015

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