Trial reportBMJ open2018
Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study.
Trial report in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Legacy effect of delayed blood pressure lowering drug treatment in middle-aged adults with mildly elevated blood pressure: systematic review and meta-analysis.Journal of human hypertension · 2020Pooled it
- Prolonged Water-Only Fasting Followed by a Whole-Plant-Food Diet Is a Potential Long-Term Management Strategy for Hypertension and Obesity.Nutrients · 2024Trial
- Effects on Cardiovascular Risk Scores and Vascular Age After Aerobic Exercise and Nutritional Intervention in Sedentary and Overweight/Obese Adults with Primary Hypertension: The EXERDIET-HTA Randomized Trial Study.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2018Trial
- Hypertensive retinopathy and cardiovascular disease risk: 6 population-based cohorts meta-analysis.International journal of cardiology. Cardiovascular risk and prevention · 2023Article
- The Wider Considerations in Closing Chronic Disease Gaps - Focus on Heart Failure and Implementation.Current cardiology reviews · 2023Review
- Article
- Gazing through time and beyond the health sector: Insights from a system dynamics model of cardiovascular disease in Australia.PloS one · 2021Article
- Identifying Who Improves or Maintains Their Food Literacy Behaviours after Completing an Adult Program.International journal of environmental research and public health · 2020Article
- Do patients or their physicians more accurately assess long-term risk associated with hypertension? A population-based study.Scandinavian journal of primary health care · 2020Article
- Identifying Participants Who Would Benefit the Most from an Adult Food-literacy Program.International journal of environmental research and public health · 2019Article
- Effectiveness of an Adult Food Literacy Program.Nutrients · 2019Article
- Renal Artery Denervation for Hypertension.Current treatment options in cardiovascular medicine · 2019Review
- Exclusively plant, whole-food diet for polypharmacy due to persistent atrial fibrillation, ischaemic cardiomyopathy, hyperlipidaemia and hypertension in an octogenarian.BMJ case reports · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIn many current guidelines, blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease (CVD) is based on absolute risk. However, in clinical practice, therapeutic decisions are often based on BP levels alone. We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure (ANBP) cohort, a seminal study establishing the efficacy of BP lowering in 'mild hypertensive' persons.
designA post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile. SETTING AND
participants3244 participants aged 35-69 years in a community-based randomised placebo controlled trial of blood pressure-lowering medication.
interventionsChlorothiazide500 mg versus placebo. PRIMARY OUTCOME MEASURES: All-cause mortality and non-fatal events (non-fatal CVD, congestive cardiac failure, renal failure, hypertensive retinopathy or encephalopathy).
resultsTreatment effects were assessed by HR, absolute risk reduction and number needed to treat. Participants had an average 5-year CVD risk in the intermediate range (10.5±6.5) with moderately elevated BP (mean 159/103 mmHg) and were middle aged (52±8 years). In a subgroup analysis, the relative effects (HR) and absolute effects (absolute risk reduction and number needed to treat) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality (p for heterogeneity=0.04). With respect to absolute benefit, drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 (10 to 64), death from any cause with 45 (25 to 196) and major CVD events with 23 (12 to 193).
conclusionOur analysis confirms that the benefit of treatment was substantial only in the high-risk tertile, reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.