There was no clear evidence that proportional risk reductions in major cardiovascular disease differed by baseline disease history , except for diabetes and chronic kidney disease , for which smaller , but significant , risk reductions were detected .
β blockers were inferior to other drugs for the prevention of major cardiovascular disease events , stroke , and renal failure .
Calcium channel blockers were superior to other drugs for the prevention of stroke .
For the prevention of heart failure , calcium channel blockers were inferior and diuretics were superior to other drug classes .
INTERPRETATION Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities .
BACKGROUND The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established .
However , the extent to which these effects differ by baseline blood pressure , presence of comorbidities , or drug class is less clear .
We therefore performed a systematic review and meta- analysis to clarify these differences .
Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party.
OBJECTIVE --To establish whether treatment with diuretic or beta blocker in hypertensive older adults reduces risk of stroke , coronary heart disease , and death . DESIGN --R and omised , placebo controlled , single blind trial . SETTING --226 general practice s in the MRC general practice research framework . SUBJECTS--4396 patients aged 65 - 74 r and omised to receive diuretic , beta blocker , or placebo . Patients had mean systolic pressures of 160 - 209 mm Hg and mean diastolic pressures less than 115 mm Hg during an eight week run in and were not taking antihypertensive treatment . INTERVENTION-- Patients were r and omised to atenolol 50 mg daily ; hydrochlorothiazide 25 mg or 50 mg plus amiloride 2.5 mg or 5 mg daily ; or placebo . The regimens were adjusted to achieve specified target pressures . Mean follow up was 5.8 years . MAIN OUTCOME MEASURES --Strokes , coronary events , and deaths from all causes . RESULTS --Both treatments reduced blood pressure below the level in the placebo group . Compared with the placebo group , actively treated subjects ( diuretic and beta blocker groups combined ) had a 25 % ( 95 % confidence interval 3 % to 42 % ) reduction in stroke ( p = 0.04 ) , 19 % ( -2 % to 36 % ) reduction in coronary events ( p = 0.08 ) , and 17 % ( 2 % to 29 % ) reduction in all cardiovascular events ( p = 0.03 ) . After adjusting for baseline characteristics the diuretic group had significantly reduced risks of stroke ( 31 % ( 3 % to 51 % ) p = 0.04 ) , coronary events ( 44 % ( 21 % to 60 % ) , p = 0.0009 ) , and all cardiovascular events ( 35 % ( 17 % to 49 % ) , p = 0.0005 ) compared with the placebo group . The beta blocker group showed no significant reductions in these end points . The reduction in strokes was mainly in non-smokers taking the diuretic . CONCLUSION --Hydrochlorothiazide and amiloride reduce the risk of stroke , coronary events , and all cardiovascular events in older hypertensive adults
There was no clear evidence that proportional risk reductions in major cardiovascular disease differed by baseline disease history , except for diabetes and chronic kidney disease , for which smaller , but significant , risk reductions were detected .
β blockers were inferior to other drugs for the prevention of major cardiovascular disease events , stroke , and renal failure .
Calcium channel blockers were superior to other drugs for the prevention of stroke .
For the prevention of heart failure , calcium channel blockers were inferior and diuretics were superior to other drug classes .
INTERPRETATION Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities .
BACKGROUND The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established .
However , the extent to which these effects differ by baseline blood pressure , presence of comorbidities , or drug class is less clear .
We therefore performed a systematic review and meta- analysis to clarify these differences .