Initial Results of the Australian Therapeutic Trial in Mild Hypertension: Report by the Management Committee

Reader, Ralph

doi:10.1042/cs057449s

Cited by 29 publications

(7 citation statements)

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“…41 However, the statistical artefact of regression to the mean is still present in such an analysis. 42 Randomised controlled trials can help minimise regression-to-the-mean effects on sample mean changes.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure status and post-exercise hypotension: an example of a spurious correlation in hypertension research?

et al. 2010

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A single bout of exercise lowers blood pressure (BP) for up to 24 h afterwards. The magnitude of this post-exercise hypotension (PEH) has been reported to be correlated most strongly to pre-exercise BP, and this apparent relationship has influenced position statements about the value of exercise in arterial hypertension. Nevertheless, this correlation could be adversely affected by mathematical coupling and regression-to-the-mean artefacts. Therefore, we aimed to examine the degree to which BP status moderates PEH while, for the first time, controlling for these statistical artefacts. A total of 32 participants, with preexercise mean arterial pressures of 65-110 mm Hg, cycled for 30 min at 70% peak oxygen uptake. Systolic BP and diastolic BP were measured (Portapres) before exercise and for 20 min after exercise. Changes in BP were regressed against pre-exercise values, and against the mean of pre-and post-exercise BP, among other indices that are also known not to be prone to artefacts. Correlations between pre-exercise BP and the exercisemediated reductions were typical of those previously reported (r ¼ 0.37-0.62, Po0.05), but not large enough to rule out spuriousness (P40.05). Artefact-free indices of BP status (pre-and post-exercise mean as well as an earlier independent measurement) did not correlate with reductions in BP (P40.05), which were moderated more by peak oxygen uptake and time of day (Po0.05). These data indicate that, if statistical artefacts are not controlled for, the influence of BP status on the degree of PEH can be spuriously exaggerated to the extent that other more important moderators of BP change are masked.

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Section: Discussionmentioning

confidence: 99%

Blood pressure status and post-exercise hypotension: an example of a spurious correlation in hypertension research?

et al. 2010

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“…There were three papers reporting bendrofluazide 9-11 outcomes, two papers using chlorothiazide, 12,13 five papers reporting five outcomes for chlorthalidone, [14][15][16][17][18] 10 papers using hydrochlorothiazide 9,11,[19][20][21][22][23][24][25][26] and one paper reporting on indapamide 27 (table 1). two of these studies used bendrofluazide or hydrochlorothiazide.…”

Section: Resultsmentioning

confidence: 99%

Should we switch from bendrofluazide to chlorthalidone as the initial treatment for hypertension? A review of the available medication

Arroll

Wallace

2017

J Prim Health Care

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INTRODUCTION Thiazide diuretics are commonly prescribed in the treatment of hypertension. However, thiazide diuretics may not all be equal in their ability to reduce cardiovascular disease outcomes. AIM To determine if bendroflumethiazide/bendrofluazide, the most commonly used diuretic for hypertension in New Zealand, is as effective as other diuretics in terms of cardiovascular disease outcomes. METHODS Using recent reviews of thiazide-like (chlorthalidone or indapamide) and thiazide-type diuretics (hydrochlorothiazide and bendrofluazide) and a separate search of bendrofluazide, data on cardiovascular disease outcomes was extracted. RESULTS Nineteen relevant papers with 21 comparisons were found. All thiazide-based diuretics have been reported in at least one trial showing them to be more effective than placebo for cardiovascular disease outcomes, with the exception of chlorothiazide. There were no comparisons of bendrofluazide alone with other medications, but there were two studies with either bendrofluazide or hydrochlorothiazide compared with β-blockers; however, the pooled relative risk (RR) was not significant (RR = 1.10 (95% CI, 0.84–1.43)). For chlorthalidone, there were four comparisons with other medications, and the summary RR was statistically significant for cardiovascular disease outcomes (RR = 0.91 (95% CI, 0.85–0.98)). Chlorthalidone was significantly more effective for some cardiovascular disease outcomes when compared with doxazosin, amlodipine and lisinopril. CONCLUSIONS All thiazide-based medicines available in New Zealand are effective in terms of cardiovascular disease outcomes compared with placebo when used for treating hypertension, with the exception of chlorothiazide. Of the diuretics available in New Zealand for hypertension, only chlorthalidone has been shown to be more effective than other blood pressure-lowering medicines. It may be time to change from using bendrofluazide and start using chlorthalidone as a treatment for hypertension.

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“…They sought to determine if it is possible to identify a high-risk group in the mildly hypertensive population. Examining outcomes in the MRC [7] and Australian [15] trials, it was clear that the initial blood-pressure levels alone provided only a poor guide to the high-risk patient within the mild range recruited to these trials (i.e., 90-110 mmHg). However, average values over periods of time gave a much better estimate [15].…”

Section: What Level Of Blood Pressure Should Be Treated?mentioning

confidence: 99%

“…Examining outcomes in the MRC [7] and Australian [15] trials, it was clear that the initial blood-pressure levels alone provided only a poor guide to the high-risk patient within the mild range recruited to these trials (i.e., 90-110 mmHg). However, average values over periods of time gave a much better estimate [15]. Subjects whose diastolic blood pressures averaged 100 mmHg or more during the Australian study showed a much higher incidence of endpoints in the placebo group.…”

Section: What Level Of Blood Pressure Should Be Treated?mentioning

confidence: 99%

The level at which blood pressure should be treated

Swales

1991

Cardiovasc Drug Ther

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The large multicenter trials of treatment in mild to moderate hypertension have shown unequivocally that the risk of stroke is reversed. The impact of treatment on ischemic heart disease is more debatable. Since there is no discontinuity in the risk of different levels of blood pressure, any advice about the level of pressure to treat must be arbitrary. The British Hypertension Society Guidelines recommend a sustained diastolic pressure of 100 mmHg or more over a 3- to 4-month period. This empirical advice is based upon subgroup analysis of the MRC and Australian Therapeutic Trials that suggests most of the benefit in treating the mildest degrees of hypertension occur in this group of patients. The role of newer classes of agent, such as ACE inhibitors or calcium-channel blockers, cannot be fully assessed in the absence of proper end-point trials. Whilst reasons for using these agents as first-line therapy have been put forward, these remain speculative in the absence of such trials. The much greater cost of newer agents in the context of universally cost-constrained health services also has to be borne in mind before recommending their widespread use as first-line therapy.

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Initial Results of the Australian Therapeutic Trial in Mild Hypertension: Report by the Management Committee

Cited by 29 publications

References 0 publications

Blood pressure status and post-exercise hypotension: an example of a spurious correlation in hypertension research?

Blood pressure status and post-exercise hypotension: an example of a spurious correlation in hypertension research?

Should we switch from bendrofluazide to chlorthalidone as the initial treatment for hypertension? A review of the available medication

The level at which blood pressure should be treated

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