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Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials

Ninomiya, Toshiharu, Perkovic, Vlado, Turnbull, Fiona, Neal, Bruce, Barzi, Frederica, Cass, Alan, Baigent, Colin, Chalmers, John, Li, N., Woodward, Mark, MacMahon, S. and Blood Pressure Lowering Treatment Trialists’ Collaboration (2013). Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials. BMJ (Online),347(7929):f5680-1-f5680-15.

Document type: Journal Article
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IRMA ID 11035xPUB59
Title Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials
Author Ninomiya, Toshiharu
Perkovic, Vlado
Turnbull, Fiona
Neal, Bruce
Barzi, Frederica
Cass, Alan
Baigent, Colin
Chalmers, John
Li, N.
Woodward, Mark
MacMahon, S.
Blood Pressure Lowering Treatment Trialists’ Collaboration
Journal Name BMJ (Online)
Publication Date 2013
Volume Number 347
Issue Number 7929
Start Page f5680-1
End Page f5680-15
Total Pages 15
Place of Publication United Kingdom
Publisher B M J Group
HERDC Category C1 - Journal Article (DIISR)
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.

DOI http://dx.doi.org/10.1136/bmj.f5680   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 3.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 3.0 License
URL https://creativecommons.org/licenses/by/3.0/au/legalcode


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