Treatment of mild hypertension: A five year controlled drug trial

Helgeland, Anders

doi:10.1016/0002-9343(80)90438-6

Cited by 608 publications

(130 citation statements)

References 22 publications

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“…Each subject underwent the same prowere reported by the Hypertension Detection and tocol: determination of sitting BP after 30 min rest Follow-up Program (HDFP). 8 However other studies, with a mercury sphygmomanometer (Korotkoff including the Veterans Administration trial 9 US phase I and V) was used as the mean of the two readPublic Health Service Hospitals trial, 10 Oslo study, 11 ings on three successive days, measurement of body and Multiple Risk Factor Intervention Trial weight and height, physical check up, quantification (MRFIT), 12 yielded no significant difference in morof fasting plasma cholesterol and serum glucose, tality or morbidity between the control and treated routine tests of blood and urine, records of 12 leads patients when the entry DBP was 90-94 mm Hg, resting ECG, and examination of ocular fundus.…”

Section: Methodsmentioning

confidence: 99%

“…One hundred and thirty-one cases of borderstroke in many clinical trials carried out in western line hypertensives diagnosed during screening for countries. [5][6][7][8][9][10][11][12] It has been recently reported that hypertension in the southern part of the Fujian Provstroke is the main complication in Asian hypertenince, were matched with a cohort of normotensives sives. [2][3][4] Since the publication of the Veterans under the same conditions, ie, age, sex, region, and Administration Co-operative Study, it has been genoccupation, and both groups were followed up for erally accepted that antihypertensive drug treatment 17 years to show the natural outcome of borderis effective in preventing cardiovascular compliline hypertension.…”

Section: Introductionmentioning

confidence: 99%

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The natural history of borderline hypertension in a Chinese population

Xie

Chen

et al. 1997

J Hum Hypertens

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One hundred and thirty-one borderline hypertensive death in borderline hypertensives was 2.35. The main cause of death was stroke, accounting for 42.5% of the patients were followed up for 17 years. A cohort of normotensives strictly matched by age, sex, region and total death rate. The relative risk rates of occurrence and death associated with stroke were 8.3 and 11.6, respectoccupation served as controls (1:1). It was found that 64.6% of borderline hypertensive patients developed ively. It is concluded that the main complication of borderline hypertension was stroke rather than coronary into established hypertensives after 17 years follow-up, 25.5% restored to normotensives and 13.8% remained heart disease, which was similar to that of established hypertension in this area. Part of the borderline hyperunchanged. The total mortality rate of borderline hypertensives was higher than that of normotensives (27.9 vs tensives need to be treated to reduce the risk of cardiovascular complications. 13.4/1000 person years), and the relative risk of total

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The natural history of borderline hypertension in a Chinese population

Xie

Chen

et al. 1997

J Hum Hypertens

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“…After excluding duplicates and after applying inclusion and exclusion criteria, we found references pertaining to 9 randomized, controlled comparisons (nϭ78 350) in which either HCTZ or CTDN was used as the base diuretic in 1 arm: 3 based on HCTZ (nϭ18 374) and 6 based on CTDN (nϭ59 976) [22][23][24][25][26][27][28][29][30][31][32][33][34][35] (See Table 1). …”

Section: Findings Of Systematic Reviewmentioning

confidence: 99%

Chlorthalidone Compared With Hydrochlorothiazide in Reducing Cardiovascular Events

2012

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Abstract-Hydrochlorothiazide (HCTZ) is widely used for hypertension, and prescriptions for HCTZ outnumber those for chlorthalidone (CTDN) by Ͼ20-fold in 2 recent surveys. Some have recently expressed a preference for CTDN. However, head-to-head trials testing the effect of the 2 drugs on cardiovascular events (CVEs) are lacking. We conducted a systematic review of randomized trials in which 1 arm was based on either HCTZ or CTDN followed by 2 types of network meta-analyses, a drug-adjusted analysis and an office systolic blood pressure-adjusted analysis. Nine trials were identified: 3 based on HCTZ and 6 based on CTDN. In the drug-adjusted analysis (nϭ50 946), the percentage of risk reduction in congestive heart failure for CTDN versus HCTZ was 23 (95% CI, 2-39; Pϭ0.032); and in all CVEs was 21 (95% CI, 12-28; PϽ0.0001). In the office systolic blood pressure-adjusted analysis (nϭ78 350), the percentage of risk reduction in CVEs for CTDN versus HCTZ was 18 (95% CI, Pϭ0.024). When the reduction in office systolic blood pressure was identical in the 2 arms, the risk for CVEs in HCTZ arms was 19% higher than in its nondiuretic comparator arms (Pϭ0.021). Relative to HCTZ, the number needed to treat with CTDN to prevent 1 CVE over 5 years was 27. In conclusion, CTDN is superior to HCTZ in preventing cardiovascular events. This cannot be attributed entirely to the lesser effect of HCTZ on office systolic blood pressure but may be attributed to the pleomorphic effects of alternative medications or to the short duration of action of HCTZ. Pharmaceutical preparations of the 2 drugs differ. HCTZ is available in 12.5-mg and 25.0-mg tablets and in 19 combination tablets, whereas CTDN is commonly available only in an unscored 25-mg tablet, an excessive dose in many patients, and in only 3 combination tablets, including atenolol, clonidine, and azilsartan. In light of the practical features of HCTZ, 2 there were 134 million prescriptions (solo or as a combination tablet) in 2007. 3 HCTZ is the 10th most commonly prescribed drug in the United States, with 48 million solo prescriptions annually from 2006 through 2010. 4 In 2 recent surveys, one in the United States and the other in Germany, HCTZ prescriptions outnumbered those for CTDN by Ͼ20-fold. 5,6 In the last several years, some have compared the drugs pharmacologically and have recommended CTDN rather than HCTZ. 3,[7][8][9][10][11][12] Two recent reanalyses of Multiple Risk Factor Intervention Trial (MRFIT) data have found CTDN to be superior to HCTZ in reducing cardiovascular events (CVEs) 13 and left ventricular hypertrophy. 14 However, no randomized, controlled trials have compared the 2 medications head to head with respect to CVEs. To examine whether 1 drug was superior over the other in reducing CVEs, we undertook a systematic review of randomized, controlled trials with either HCTZ or CTDN as the step 1 agent and then conducted 2 different types of network analyses. MethodsPreferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines were followed th...

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“…Briefly, despite the fact that PHARM evaluated only short-term trials (weeks), the absolute risk of events (events per 1000 patient years) observed in PHARM fell well within the range of the absolute event rates in long-term trials, [17][18][19][20][21][22][23][24][25][26][27][28][29] for patients within the chronological age and magnitude of systolic BP defined by the PHARM population baseline values. For example, the total all cause mortality rate in PHARM was 3.4 per 1000 patient years, only slightly less than that reported by the CDC Division of Vital Statistics 30 for the year 2003 for this age group in the general population of the United States and total stroke events in PHARM was 3.1 per 1000 patient years, slightly greater than that seen in the MRC trial 20 and the Australian trial 19 in hypertensive populations.…”

Section: Establishment Of Contextmentioning

confidence: 99%

The risks associated with short-term placebo-controlled antihypertensive clinical trials: a descriptive meta-analysis

DeFelice¹,

Willard²,

Lawrence

et al. 2008

J Hum Hypertens

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Short-term (4-8 weeks) placebo-controlled trials are used to evaluate new antihypertensive drug treatment. To evaluate the consequences of such practice, a descriptive meta-analysis was conducted, consisting of blinded review of original case report forms for all patients who died or left a study before its completion for all short-term, placebo-controlled hypertension trials submitted to the Food and Drug Administration from 1973 through 2001. There were 93 marketing applications or supplements involving 590 individual trials that involved 86 137 randomized patients (64 438 randomized to experimental drug and 21 699 randomized to placebo) with 12 658 patient years of observation. There were 9636 dropouts (mean time to dropout was 28 days) and relative risk (RR (placebo/drug)) ¼ 1.33 (95% confidence limits, 1.28, 1.39; Po10 À16 ). As expected, lack of blood pressure (BP) control was far more common in patients randomized to placebo; therapeutic failure, RR ¼ 2.53 (2.35, 2.73; Po10 À15 ) and hypertensive emergency, RR ¼ 2.75 (2.19, 3.57; Po10 À15 ). When administrative dropouts and dropouts resulting from inadequate BP control were excluded, the remaining 38% of dropouts were disproportionately more from drug (2810 drug, 816 placebo), RR ¼ 0.80 (0.74, 0.86; Po10 À8 ). There were 43 deaths, RR ¼ 0.72 (0.33, 1.45; P ¼ 0.37); 40 strokes, RR ¼ 1.43 (0.68, 2.81; P ¼ 0.33) and 77 myocardial infarctions, RR ¼ 1.06 (0.62, 1.75; P ¼ 0.82). Irreversible harm (a combination of death, stroke and myocardial infarction, 160 total events) was equally distributed between the drug and placebo groups, RR ¼ 1.03 (0.71, 1.47; P ¼ 0.86).

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Treatment of mild hypertension: A five year controlled drug trial

Cited by 608 publications

References 22 publications

The natural history of borderline hypertension in a Chinese population

The natural history of borderline hypertension in a Chinese population

Chlorthalidone Compared With Hydrochlorothiazide in Reducing Cardiovascular Events

The risks associated with short-term placebo-controlled antihypertensive clinical trials: a descriptive meta-analysis

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