Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials
Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or e...
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| Veröffentlicht in: | BMJ (Online) 2013-10, Vol.347 (7929), p.12-12 |
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| creator | Ninomiya, T Perkovic, V Turnbull, F Neal, B Barzi, F Cass, A Baigent, C Chalmers, J Li, N Woodward, M MacMahon, S |
| description | Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm.Main outcome measures Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death.Participants 26 trials (152 290 participants), including 30 295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFR 0.60 for homogeneity).Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease. |
| doi_str_mv | 10.1136/bmj.f5680 |
| format | Article |
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Meta-analysis according to baseline kidney function was performed. Pooled hazard ratios per 5 mm Hg lower blood pressure were estimated with a random effects model.Results Compared with placebo, blood pressure lowering regimens reduced the risk of major cardiovascular events by about a sixth per 5 mm Hg reduction in systolic blood pressure in individuals with (hazard ratio 0.83, 95% confidence interval 0.76 to 0.90) and without reduced eGFR (0.83, 0.79 to 0.88), with no evidence for any difference in effect (P=1.00 for homogeneity). The results were similar irrespective of whether blood pressure was reduced by regimens based on angiotensin converting enzyme inhibitors, calcium antagonists, or diuretics/β blockers. There was no evidence that the effects of different drug classes on major cardiovascular events varied between patients with different eGFR (all P>0.60 for homogeneity).Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.</description><edition>International edition</edition><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 1756-1833</identifier><identifier>ISSN: 0959-8146</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.f5680</identifier><identifier>PMID: 24092942</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Angiotensin ; Antagonists ; Antihypertensive Agents - therapeutic use ; Blood pressure ; Blood Pressure - drug effects ; Calcium antagonists ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - physiopathology ; Cardiovascular Diseases - prevention & control ; Cerebral infarction ; Clinical trials ; Collaboration ; Diuretics ; Epidermal growth factor receptors ; Evidence-based medicine ; Experimentation ; Glomerular filtration rate ; Glomerular Filtration Rate - drug effects ; Glomerular Filtration Rate - physiology ; Heart diseases ; Humans ; Kidney diseases ; Kidney transplantation ; Medical research ; Meta-analysis ; Mortality ; Myocardial infarction ; Peptidyl-dipeptidase A ; Randomized Controlled Trials as Topic ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - physiopathology</subject><ispartof>BMJ (Online), 2013-10, Vol.347 (7929), p.12-12</ispartof><rights>Blood Pressure Lowering Treatment Trialists’ Collaboration 2013</rights><rights>BMJ Publishing Group Ltd 2013</rights><rights>Copyright BMJ Publishing Group Oct 19, 2013</rights><rights>Copyright: 2013 © Blood Pressure Lowering Treatment Trialists' Collaboration 2013</rights><rights>Blood Pressure Lowering Treatment Trialists’ Collaboration 2013 2013 Blood Pressure Lowering Treatment Trialists’ Collaboration</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b520t-52bb58fbbaee8bc3d07444abf4fe77e2f40b42eb704fc073b777f496e9a979263</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/347/bmj.f5680.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/347/bmj.f5680.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,776,780,799,881,3182,23551,27903,27904,30978,57996,58229,77347,77378</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24092942$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ninomiya, T</creatorcontrib><creatorcontrib>Perkovic, V</creatorcontrib><creatorcontrib>Turnbull, F</creatorcontrib><creatorcontrib>Neal, B</creatorcontrib><creatorcontrib>Barzi, F</creatorcontrib><creatorcontrib>Cass, A</creatorcontrib><creatorcontrib>Baigent, C</creatorcontrib><creatorcontrib>Chalmers, J</creatorcontrib><creatorcontrib>Li, N</creatorcontrib><creatorcontrib>Woodward, M</creatorcontrib><creatorcontrib>MacMahon, S</creatorcontrib><creatorcontrib>Blood Pressure Lowering Treatment Trialists' Collaboration</creatorcontrib><title>Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm.Main outcome measures Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death.Participants 26 trials (152 290 participants), including 30 295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFR <60 mL/min/1.73m2.Data extraction Individual participant data were available for 23 trials, with summary data from another three. Meta-analysis according to baseline kidney function was performed. Pooled hazard ratios per 5 mm Hg lower blood pressure were estimated with a random effects model.Results Compared with placebo, blood pressure lowering regimens reduced the risk of major cardiovascular events by about a sixth per 5 mm Hg reduction in systolic blood pressure in individuals with (hazard ratio 0.83, 95% confidence interval 0.76 to 0.90) and without reduced eGFR (0.83, 0.79 to 0.88), with no evidence for any difference in effect (P=1.00 for homogeneity). The results were similar irrespective of whether blood pressure was reduced by regimens based on angiotensin converting enzyme inhibitors, calcium antagonists, or diuretics/β blockers. There was no evidence that the effects of different drug classes on major cardiovascular events varied between patients with different eGFR (all P>0.60 for homogeneity).Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.</description><subject>Angiotensin</subject><subject>Antagonists</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Blood pressure</subject><subject>Blood Pressure - drug effects</subject><subject>Calcium antagonists</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cerebral infarction</subject><subject>Clinical trials</subject><subject>Collaboration</subject><subject>Diuretics</subject><subject>Epidermal growth factor receptors</subject><subject>Evidence-based medicine</subject><subject>Experimentation</subject><subject>Glomerular filtration rate</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Glomerular Filtration Rate - physiology</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Kidney transplantation</subject><subject>Medical research</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Peptidyl-dipeptidase A</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><issn>0959-8138</issn><issn>1756-1833</issn><issn>0959-8146</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kcFu1DAQhi0EoqulBx4AZAkuPaTYjh3HHJBgBQWpKocCV8tOJl1vkzi1k233TXhcvE1ZwQFOM9L_zeif-RF6TskppXnxxnab00YUJXmEFlSKIqNlnj9GC6KEykqal0foOMYNIYTlslSFeIqOGCeKKc4W6OeH1vsaDwFinALg1t9CcP0VNn2NO7PxAVcm1M5vTaym1gQMW-jHiF2PB_BDC_jWjet7fN_4acTVOvjeVfja1T3scO0imAhvcQejyUxv2l10EfsGhzTluyTXuPL9GHzbpnYMzrTxGXrSpALHD3WJvn_6-G31OTv_evZl9f48s4KRMRPMWlE21hqA0lZ5TSTn3NiGNyAlsIYTyxlYSXhTEZlbKWXDVQHKKKlYkS_Ru3nvMNkO6iodF0yrh-A6E3baG6f_Vnq31ld-q_fPFOnVS_TqYUHwNxPEUW_8FNKVUVPFRSkLRuV_KV4QWnBJSKJOZqoKPsYAzcEHJXqftk5p6_u0E_vyT-MH8ne2CXgxA5s4-nDQeS4oE8n5EmWz7uIIdwfdhGtdyFwKffFjpVcX8pLwS6nPEv965vce_u3rF9rOzlI</recordid><startdate>20131003</startdate><enddate>20131003</enddate><creator>Ninomiya, 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pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials</title><author>Ninomiya, T ; Perkovic, V ; Turnbull, F ; Neal, B ; Barzi, F ; Cass, A ; Baigent, C ; Chalmers, J ; Li, N ; Woodward, M ; MacMahon, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b520t-52bb58fbbaee8bc3d07444abf4fe77e2f40b42eb704fc073b777f496e9a979263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Angiotensin</topic><topic>Antagonists</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Blood pressure</topic><topic>Blood Pressure - drug effects</topic><topic>Calcium antagonists</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - physiopathology</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cerebral infarction</topic><topic>Clinical trials</topic><topic>Collaboration</topic><topic>Diuretics</topic><topic>Epidermal growth factor receptors</topic><topic>Evidence-based medicine</topic><topic>Experimentation</topic><topic>Glomerular filtration rate</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Glomerular Filtration Rate - physiology</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Kidney transplantation</topic><topic>Medical research</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Peptidyl-dipeptidase A</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ninomiya, T</creatorcontrib><creatorcontrib>Perkovic, V</creatorcontrib><creatorcontrib>Turnbull, F</creatorcontrib><creatorcontrib>Neal, B</creatorcontrib><creatorcontrib>Barzi, F</creatorcontrib><creatorcontrib>Cass, A</creatorcontrib><creatorcontrib>Baigent, C</creatorcontrib><creatorcontrib>Chalmers, J</creatorcontrib><creatorcontrib>Li, N</creatorcontrib><creatorcontrib>Woodward, M</creatorcontrib><creatorcontrib>MacMahon, S</creatorcontrib><creatorcontrib>Blood Pressure Lowering Treatment Trialists' Collaboration</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & 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Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ninomiya, T</au><au>Perkovic, V</au><au>Turnbull, F</au><au>Neal, B</au><au>Barzi, F</au><au>Cass, A</au><au>Baigent, C</au><au>Chalmers, J</au><au>Li, N</au><au>Woodward, M</au><au>MacMahon, S</au><aucorp>Blood Pressure Lowering Treatment Trialists' Collaboration</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2013-10-03</date><risdate>2013</risdate><volume>347</volume><issue>7929</issue><spage>12</spage><epage>12</epage><pages>12-12</pages><issn>0959-8138</issn><issn>1756-1833</issn><issn>0959-8146</issn><eissn>1756-1833</eissn><coden>BMJOAE</coden><abstract>Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm.Main outcome measures Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death.Participants 26 trials (152 290 participants), including 30 295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFR <60 mL/min/1.73m2.Data extraction Individual participant data were available for 23 trials, with summary data from another three. Meta-analysis according to baseline kidney function was performed. Pooled hazard ratios per 5 mm Hg lower blood pressure were estimated with a random effects model.Results Compared with placebo, blood pressure lowering regimens reduced the risk of major cardiovascular events by about a sixth per 5 mm Hg reduction in systolic blood pressure in individuals with (hazard ratio 0.83, 95% confidence interval 0.76 to 0.90) and without reduced eGFR (0.83, 0.79 to 0.88), with no evidence for any difference in effect (P=1.00 for homogeneity). The results were similar irrespective of whether blood pressure was reduced by regimens based on angiotensin converting enzyme inhibitors, calcium antagonists, or diuretics/β blockers. There was no evidence that the effects of different drug classes on major cardiovascular events varied between patients with different eGFR (all P>0.60 for homogeneity).Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>24092942</pmid><doi>10.1136/bmj.f5680</doi><tpages>1</tpages><edition>International edition</edition><oa>free_for_read</oa></addata></record> |
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| ispartof | BMJ (Online), 2013-10, Vol.347 (7929), p.12-12 |
| issn | 0959-8138 1756-1833 0959-8146 1756-1833 |
| language | eng |
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| source | MEDLINE; BMJ Journals - NESLi2; Applied Social Sciences Index & Abstracts (ASSIA); Jstor Complete Legacy |
| subjects | Angiotensin Antagonists Antihypertensive Agents - therapeutic use Blood pressure Blood Pressure - drug effects Calcium antagonists Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - etiology Cardiovascular Diseases - physiopathology Cardiovascular Diseases - prevention & control Cerebral infarction Clinical trials Collaboration Diuretics Epidermal growth factor receptors Evidence-based medicine Experimentation Glomerular filtration rate Glomerular Filtration Rate - drug effects Glomerular Filtration Rate - physiology Heart diseases Humans Kidney diseases Kidney transplantation Medical research Meta-analysis Mortality Myocardial infarction Peptidyl-dipeptidase A Randomized Controlled Trials as Topic Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - physiopathology |
| title | Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials |
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