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 .
Practitioner's trial on the efficacy of antihypertensive treatment in elderly patients with hypertension II (PATE-hypertension II study) in Japan.
AIM Reduction of elevated blood pressure ( BP ) has been an important treatment goal in elderly hypertensive patients . However , it has been reported that an excessive reduction of systolic BP to less than 120mmHg might be harmful in such patients . We investigated whether this was the case in a study which assessed long-term antihypertensive efficacy , tolerability and impact on cardiovascular/cerebrovascular ( CV ) morbidity/mortality in a large cohort of Japanese patients . METHODS This study was performed at general practitioners ' offices nationwide with a target sample size of 1500 patients . Hypertensive patients aged 60years or more who achieved successful BP control with c and esartan monotherapy , and who tolerated the treatment for at least 8weeks , were enrolled into the study and followed for 3years . RESULTS BP was maintained below the target level of 140/90mmHg over the 3-year period . The incidence of CV events during the study period was 20.4/1000person-years . Investigation of the relationship between BP and the incidence of CV events revealed that patients with higher BP generally had a higher incidence of events . However , very elderly patients ( ≥75years ) with a systolic BP ( SBP ) of less than 120mmHg also had a higher incidence of CV events compared with those with an SBP of 120 - 139mmHg . CONCLUSION This study demonstrated that treatment with c and esartan maintained long-term control of BP in elderly hypertensive patients without serious adverse events . CV events demonstrated a J-curve relationship with SBP in patients aged 75years or older , which suggests that excessive BP reductions might be harmful for very elderly patients
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 .