Capri G Foy1, Laura C Lovato2, Mara Z Vitolins3, Jeffrey T Bates4, Ruth Campbell5, William C Cushman6, Stephen P Glasser7, Avrum Gillespie8, William J Kostis9, Marie Krousel-Wood10, Joseph B Muhlestein11,12, Suzanne Oparil13, Kwame Osei14, Roberto Pisoni5, Mark S Segal15, Alan Wiggers16, Karen C Johnson17. 1. Division of Public Health Sciences, Department of Social Sciences and Health Policy. 2. Division of Public Health Sciences, Department of Biostatistical Sciences. 3. Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina. 4. Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, Texas. 5. Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. 6. Veterans Affairs Medical Center, Preventive Medicine Section, Medical Service, Memphis, Tennessee. 7. Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 8. Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania. 9. Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey. 10. Departments of Medicine and Epidemiology, Ochsner Health System, Tulane University, New Orleans, Louisiana. 11. Intermountain Medical Center Heart Institute, Murray. 12. University of Utah School of Medicine, Salt Lake City, Utah. 13. Division of Cardiovascular Disease, Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham (UAB), Birmingham, Alabama. 14. Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Medical Center, Columbus, Ohio. 15. Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainsville, Florida. 16. Cleveland Medical Center, UH Harrington Heart and Vascular Institute, Cleveland, Ohio. 17. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Abstract
BACKGROUND: To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 120 mmHg) versus standard lowering (goal of less than 140 mmHg) upon cardiovascular, renal, and safety outcomes differed by gender. METHODS: Nine thousand three hundred and sixty-one men and women aged 50 years or older with systolic blood pressure of 130 mmHg or greater, taking 0-4 antihypertensive medications, and with increased risk of cardiovascular disease, but free of diabetes, were randomly assigned to either a systolic blood pressure target of less than 120 mmHg (intensive treatment) or a target of less than 140 mmHg (standard treatment). The primary composite outcome encompassed incident myocardial infarction, heart failure, other acute coronary syndromes, stroke, or cardiovascular-related death. All-cause mortality, renal outcomes, and serious adverse events were also assessed. RESULTS: Compared with the standard treatment group, the primary composite outcome in the intensive treatment group was reduced by 16% [hazard ratio 0.84 (0.61-1.13)] in women, and by 27% in men [hazard ratio 0.73 (0.59-0.89), P value for interaction between treatment and gender is 0.45]. Similarly, the effect of the intensive treatment on individual components of the primary composite outcome, renal outcomes, and overall serious adverse events was not significantly different according to gender. CONCLUSION: In adults with hypertension but not with diabetes, treatment to a systolic blood pressure goal of less than 120 mmHg, compared with a goal of less than 140 mmHg, resulted in no heterogeneity of effect between men and women on cardiovascular or renal outcomes, or on rates of serious adverse events.ClinicalTrials.gov number, NCT01206062.
BACKGROUND: To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 120 mmHg) versus standard lowering (goal of less than 140 mmHg) upon cardiovascular, renal, and safety outcomes differed by gender. METHODS: Nine thousand three hundred and sixty-one men and women aged 50 years or older with systolic blood pressure of 130 mmHg or greater, taking 0-4 antihypertensive medications, and with increased risk of cardiovascular disease, but free of diabetes, were randomly assigned to either a systolic blood pressure target of less than 120 mmHg (intensive treatment) or a target of less than 140 mmHg (standard treatment). The primary composite outcome encompassed incident myocardial infarction, heart failure, other acute coronary syndromes, stroke, or cardiovascular-related death. All-cause mortality, renal outcomes, and serious adverse events were also assessed. RESULTS: Compared with the standard treatment group, the primary composite outcome in the intensive treatment group was reduced by 16% [hazard ratio 0.84 (0.61-1.13)] in women, and by 27% in men [hazard ratio 0.73 (0.59-0.89), P value for interaction between treatment and gender is 0.45]. Similarly, the effect of the intensive treatment on individual components of the primary composite outcome, renal outcomes, and overall serious adverse events was not significantly different according to gender. CONCLUSION: In adults with hypertension but not with diabetes, treatment to a systolic blood pressure goal of less than 120 mmHg, compared with a goal of less than 140 mmHg, resulted in no heterogeneity of effect between men and women on cardiovascular or renal outcomes, or on rates of serious adverse events.ClinicalTrials.gov number, NCT01206062.
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