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Title: Blood-pressure lowering in intermediate-risk persons without cardiovascular disease
Authors: Lonn, Eva
Bosch, Jackie
López Jaramillo, Patricio
Zhu, Jun
Liu, Lisheng
Pais, Prem
Diaz, Rafael
Xavier, Denis
Sliwa, Karen
Dans, Antonio
Avezum, Alvaro
Leopoldo S., Piegas
Keltai, Katalin
Keltai, Matyas
Chazova, Irina
Peters, Ron J.G.
Held, Claes
Yusoff, Khalid
Lewis, Basil S.
Jansky, Petr
Parkhomenko, Alexander
Khunti, Kamlesh
Toff, William D.
Reid, Christopher M.
Varigos, John
Leiter, Lawrence A.
Molina, Dora I.
McKelvie, Robert
Pogue, Janice
Wilkinson, Joanne
Jung, Hyejung
Dagenais, Gilles
Yusuf, Salim
HOPE-3 Investigators
Issue Date: 26-Apr-2016
Abstract: BACKGROUND Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTS The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). CONCLUSIONS Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; number, NCT00468923.)
Description: 12 p.
ISSN: 1533-4406
Appears in Collections:DCABA. Artículos de Investigación

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