What question did this study set out to answer?

To evaluate blood pressure reduction, adverse event prevalence, and cardiovascular risk reduction produced by five major classes of blood pressure lowering drugs at varying single and combination doses.

June 25, 2003BMJOpen Access

Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials

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Why the study?

Does low dose combination treatment with blood pressure lowering drugs improve blood pressure reduction and minimize adverse effects compared to placebo?

Population

56,000 patients pooled from 354 randomised double blind placebo controlled trials

Comparison

Blood pressure lowering drugs in fixed dose… vs Placebo

Design

Meta-analysis, randomised (included trials), double blind (included trials)

Authors

MLMichael LawUniversity of Hawaiʻi at Mānoa

Discussion

Member takes

Overview

Low-dose triple combinations merit first-line consideration in hypertension for greater efficacy and tolerability; extends RCT meta-analysis evidence for additive BP lowering across drug classes.

Key Points

To evaluate blood pressure reduction, adverse event prevalence, and cardiovascular risk reduction produced by five major classes of blood pressure lowering drugs at varying single and combination doses.
Meta-analysis of 354 randomized double-blind placebo-controlled trials examining fixed doses of thiazides, beta blockers, ACE inhibitors, angiotensin II receptor antagonists, and calcium channel blockers.
Included 40,000 treated patients and 16,000 placebo controls to calculate placebo-adjusted systolic and diastolic blood pressure reductions and adverse symptom prevalence.
Standard-dose monotherapy lowered blood pressure by an average of 9.1 mm Hg systolic and 5.5 mm Hg diastolic, whereas half-standard dose achieved 7.1 mm Hg systolic and 4.4 mm Hg diastolic reductions.
Blood pressure reductions from different drug categories were additive, while adverse symptoms were dose-dependent and less than additive when combining two drugs.
A combination of three drugs at half-standard dose is estimated to reduce blood pressure by 20 mm Hg systolic and 11 mm Hg diastolic, reducing stroke risk by 63% and ischaemic heart disease events by 46% at age 60–69.

Structured PICO

Does low dose combination treatment with blood pressure lowering drugs improve blood pressure reduction and minimize adverse effects compared to placebo?

Population

56,000 patients (40,000 treated, 16,000 placebo) pooled from 354 randomised double blind placebo controlled trials

Intervention

Blood pressure lowering drugs (thiazides, beta blockers, ACE inhibitors, angiotensin II receptor antagonists, and calcium channel blockers) in fixed dose, singly and in combination, at standard and half-standard doses

Comparator

Placebo

Outcome

Placebo adjusted reductions in systolic and diastolic blood pressure and prevalence of adverse effects, according to dosesurrogate

Low-dose combination therapy with blood pressure lowering drugs provides additive blood pressure reduction with fewer dose-dependent adverse effects compared to standard-dose monotherapy.

Cite This Study

Michael Law (2003) studied this question.

synapsesocial.com/papers/6a7ca682a64782d1c66ee615 https://doi.org/10.1136/bmj.326.7404.1427

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June 25, 2003BMJOpen Access

Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials

View Full Paper

Ask AI

Bookmark

Why the study?

Does low dose combination treatment with blood pressure lowering drugs improve blood pressure reduction and minimize adverse effects compared to placebo?

Population

56,000 patients pooled from 354 randomised double blind placebo controlled trials

Comparison

Blood pressure lowering drugs in fixed dose… vs Placebo

Design

Meta-analysis, randomised (included trials), double blind (included trials)

Authors

MLMichael LawUniversity of Hawaiʻi at Mānoa

Discussion

Member takes

Overview

Low-dose triple combinations merit first-line consideration in hypertension for greater efficacy and tolerability; extends RCT meta-analysis evidence for additive BP lowering across drug classes.

Key Points

To evaluate blood pressure reduction, adverse event prevalence, and cardiovascular risk reduction produced by five major classes of blood pressure lowering drugs at varying single and combination doses.
Meta-analysis of 354 randomized double-blind placebo-controlled trials examining fixed doses of thiazides, beta blockers, ACE inhibitors, angiotensin II receptor antagonists, and calcium channel blockers.
Included 40,000 treated patients and 16,000 placebo controls to calculate placebo-adjusted systolic and diastolic blood pressure reductions and adverse symptom prevalence.
Standard-dose monotherapy lowered blood pressure by an average of 9.1 mm Hg systolic and 5.5 mm Hg diastolic, whereas half-standard dose achieved 7.1 mm Hg systolic and 4.4 mm Hg diastolic reductions.
Blood pressure reductions from different drug categories were additive, while adverse symptoms were dose-dependent and less than additive when combining two drugs.
A combination of three drugs at half-standard dose is estimated to reduce blood pressure by 20 mm Hg systolic and 11 mm Hg diastolic, reducing stroke risk by 63% and ischaemic heart disease events by 46% at age 60–69.

Structured PICO

Does low dose combination treatment with blood pressure lowering drugs improve blood pressure reduction and minimize adverse effects compared to placebo?

Population

56,000 patients (40,000 treated, 16,000 placebo) pooled from 354 randomised double blind placebo controlled trials

Intervention

Comparator

Placebo

Outcome

Placebo adjusted reductions in systolic and diastolic blood pressure and prevalence of adverse effects, according to dosesurrogate

Low-dose combination therapy with blood pressure lowering drugs provides additive blood pressure reduction with fewer dose-dependent adverse effects compared to standard-dose monotherapy.

Cite This Study

Michael Law (2003) studied this question.

synapsesocial.com/papers/6a7ca682a64782d1c66ee615 https://doi.org/10.1136/bmj.326.7404.1427

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