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Title: Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
Authors: Lonn, E. M.
Bosch, J.
López-Jaramillo, P.
Zhu, J.
Liu, L.
Pais, P.
Diaz, R.
Xavier, D.
Sliwa, K.
Dans, A.
Avezum, A.
Piegas, L. S.
Keltai, K.
Keltai, M.
Chazova, I.
Peters, R. J.
Held, C.
Yusoff, K.
Lewis, B. S.
Jansky, P.
Parkhomenko, A.
Khunti, Kamlesh
Toff, William D.
Reid, C. M.
Varigos, J.
Leiter, L. A.
Molina, D. I.
McKelvie, R.
Pogue, J.
Wilkinson, J.
Jung, H.
Dagenais, G.
Yusuf, S.
HOPE-3 Investigators
First Published: 2-Apr-2016
Publisher: Massachusetts Medical Society
Citation: New England Journal of Medicine, 2016, 374 (21), pp. 2009-2020
Abstract: BACKGROUND: Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS: In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTS: The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). CONCLUSIONS: Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; number, NCT00468923.).
DOI Link: 10.1056/NEJMoa1600175
eISSN: 1533-4406
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2016 Massachusetts Medical Society. All rights reserved. Deposited with reference to the publisher’s open access archiving policy.
Description: The file associated with this record is under embargo for 6 months from first publication.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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