Hisato Takagi1, Takuya Umemoto. 1. Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan, kfgth973@ybb.ne.jp.
Abstract
OBJECTIVE: Lowering systolic blood pressure (BP) (SBP) by 10 mmHg or diastolic BP by 5 mmHg using any of the main classes of BP lowering drugs reduces stroke by about a third. The objective of the present study is to determine whether there is a limit to the extent to which BP should be lowered. METHODS: From the individual 17 primary-prevention trials of single drug therapy included in a recent meta-analysis, we abstracted reductions in SBP (SBP reduction in the treatment group minus that in the control group [mmHg]) and data regarding incidence of stroke to generate relative risks (RRs). We performed "flexible" (not "linear") unrestricted maximum likelihood meta-regression, using fractional polynomials, of the reduction in SBP on the risk of stroke. RESULTS: The best-fitting model offered a gain in deviance of 5.71 with respect to the reference linear model, according to the expected inverse J-shaped (nadir at a 13.7-mmHg reduction in SBP) dose-response relation between reductions in SBP and logarithmic RRs for stroke. CONCLUSIONS: More than 13.7-mmHg SBP reduction with single drug therapy could produce no longer additional reduction in the risk of stroke in a primary-prevention setting.
OBJECTIVE: Lowering systolic blood pressure (BP) (SBP) by 10 mmHg or diastolic BP by 5 mmHg using any of the main classes of BP lowering drugs reduces stroke by about a third. The objective of the present study is to determine whether there is a limit to the extent to which BP should be lowered. METHODS: From the individual 17 primary-prevention trials of single drug therapy included in a recent meta-analysis, we abstracted reductions in SBP (SBP reduction in the treatment group minus that in the control group [mmHg]) and data regarding incidence of stroke to generate relative risks (RRs). We performed "flexible" (not "linear") unrestricted maximum likelihood meta-regression, using fractional polynomials, of the reduction in SBP on the risk of stroke. RESULTS: The best-fitting model offered a gain in deviance of 5.71 with respect to the reference linear model, according to the expected inverse J-shaped (nadir at a 13.7-mmHg reduction in SBP) dose-response relation between reductions in SBP and logarithmic RRs for stroke. CONCLUSIONS: More than 13.7-mmHg SBP reduction with single drug therapy could produce no longer additional reduction in the risk of stroke in a primary-prevention setting.
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