Lancet. 2014 Aug 16;384(9943):591-598. doi: 10.1016/S0140-6736(14)61212-5.
We aimed to investigate whether the benefits of blood pressure-lowering drugs are proportional to baseline cardiovascular risk, to establish whether absolute risk could be used to inform treatment decisions for blood pressure-lowering therapy, as is recommended for lipid-lowering therapy.
This meta-analysis included individual participant data from trials that randomly assigned patients to either blood pressure-lowering drugs or placebo, or to more intensive or less intensive blood pressure-lowering regimens. The primary outcome was total major cardiovascular events, consisting of stroke, heart attack, heart failure, or cardiovascular death. Participants were separated into four categories of baseline 5-year major cardiovascular risk using a risk prediction equation developed from the placebo groups of the included trials (<11%, 11-15%, 15-21%, >21%).
11 trials and 26 randomised groups met the inclusion criteria, and included 67,475 individuals, of whom 51,917 had available data for the calculation of the risk equations. 4167 (8%) had a cardiovascular event during a median of 4·0 years (IQR 3·4-4·4) of follow-up. The mean estimated baseline levels of 5-year cardiovascular risk for each of the four risk groups were 6·0% (SD 2·0), 12·1% (1·5), 17·7% (1·7), and 26·8% (5·4). In each consecutive higher risk group, blood pressure-lowering treatment reduced the risk of cardiovascular events relatively by 18% (95% CI 7-27), 15% (4-25), 13% (2-22), and 15% (5-24), respectively (p=0·30 for trend). However, in absolute terms, treating 1000 patients in each group with blood pressure-lowering treatment for 5 years would prevent 14 (95% CI 8-21), 20 (8-31), 24 (8-40), and 38 (16-61) cardiovascular events, respectively (p=0·04 for trend).
Lowering blood pressure provides similar relative protection at all levels of baseline cardiovascular risk, but progressively greater absolute risk reductions as baseline risk increases. These results support the use of predicted baseline cardiovascular disease risk equations to inform blood pressure-lowering treatment decisions.
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我们旨在探究降压药物的获益是否与基线心血管风险呈比例关系，以确定绝对风险是否可用于指导降压治疗的决策，就像降脂治疗那样。
本项荟萃分析纳入了来自随机分配患者接受降压药物或安慰剂、或更强化或非强化降压方案的试验的个体参与者数据。主要结局是卒中、心肌梗死、心力衰竭或心血管死亡的总主要心血管事件。参与者根据纳入试验安慰剂组开发的风险预测方程，分为基线 5 年主要心血管风险的四个类别（<11%、11-15%、15-21%、>21%）。
11 项试验和 26 个随机分组符合纳入标准，共纳入 67475 人，其中 51917 人有风险方程计算的可用数据。4167 人（8%）在中位数为 4.0 年（3.4-4.4 年）的随访期间发生心血管事件。四个风险组的平均估计基线 5 年心血管风险分别为 6.0%（2.0）、12.1%（1.5）、17.7%（1.7）和 26.8%（5.4）。在每个连续的更高风险组中，降压治疗分别使心血管事件风险降低相对 18%（95%CI 7-27）、15%（4-25）、13%（2-22）和 15%（5-24）（趋势检验 p=0.30）。然而，从绝对数值来看，在每个组中，治疗 1000 名患者 5 年，分别可预防 14 例（95%CI 8-21）、20 例（8-31）、24 例（8-40）和 38 例（16-61）心血管事件（趋势检验 p=0.04）。
在所有基线心血管风险水平，降压均提供相似的相对保护，但随着基线风险的增加，绝对风险降低幅度逐渐增大。这些结果支持使用预测的基线心血管疾病风险方程来指导降压治疗决策。
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