March 19, 2002Annals of Internal Medicine
J-Shaped Relationship between Blood Pressure and Mortality in Hypertensive Patients: New Insights from a Meta-Analysis of Individual-Patient Data
Why the study?
Does antihypertensive treatment alter the J-shaped relationship between blood pressure and mortality in patients with hypertension?
Population
40,233 persons with hypertension from 7 randomized clinical trials in the INDANA database
Comparison
Antihypertensive treatment vs Placebo or no treatment
Design
Meta-analysis
Follow-up
mean 3.9 years
Authors
Discussion
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Implication
Antihypertensive therapy does not induce J-curve mortality risk; confirms reverse causation from frailty rather than treatment effect.
Key Points
- To evaluate the evidence for a J-shaped association between blood pressure levels and mortality, and to determine whether this relationship is driven by antihypertensive treatment.
- Conducted an individual-patient data meta-analysis of 7 randomized clinical trials from the INDANA database comprising 40,233 hypertensive individuals (mean follow-up, 3.9 years).
- Compared regimens predominantly based on beta-blockers or thiazide diuretics against placebo or no treatment, evaluating systolic and diastolic blood pressure and yearly cardiovascular, noncardiovascular, and all-cause deaths.
- Across 1,655 total deaths (56% cardiovascular), a J-shaped relationship between diastolic blood pressure and both all-cause and cardiovascular mortality was observed in treated patients (nadirs at 84 and 80 mm Hg, respectively) and untreated patients (nadirs at 90 and 85 mm Hg, respectively).
- For noncardiovascular mortality, the diastolic relationship was J-shaped in treated patients (nadir 84 mm Hg) but negative in control subjects, with similar patterns identified for systolic blood pressure that were not explained by wide pulse pressure.
Structured PICO
Does antihypertensive treatment alter the J-shaped relationship between blood pressure and mortality in patients with hypertension?
P
Population
40,233 persons with hypertension from 7 randomized clinical trials in the INDANA database
I
Intervention
Antihypertensive treatment (primarily beta-blockers or thiazide diuretics)
C
Comparator
Placebo or no treatment
O
Outcome
All-cause, cardiovascular, and noncardiovascular mortality in yearly periods of follow-uphard clinical
The J-shaped relationship between blood pressure and mortality in hypertensive patients is likely due to poor health conditions causing low blood pressure, rather than being a direct consequence of antihypertensive treatment.
Cite This Study
Boutitie et al. (2002) studied this question.