Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis.
OBJECTIVE: Persistent long-term benefits after discontinuation of treatment have been suggested for blood pressure-lowering and lipid-lowering treatment. We conducted a systematic review to assess the long-term effects of blood pressure (BP) lowering (BPL) and lipid lowering on all-cause and cardio...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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Lippincott, Williams & Wilkins
2017
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| _version_ | 1797088412709158912 |
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| author | Hirakawa, Y Arima, H Rodgers, A Woodward, M Chalmers, J |
| author_facet | Hirakawa, Y Arima, H Rodgers, A Woodward, M Chalmers, J |
| author_sort | Hirakawa, Y |
| collection | OXFORD |
| description | OBJECTIVE: Persistent long-term benefits after discontinuation of treatment have been suggested for blood pressure-lowering and lipid-lowering treatment. We conducted a systematic review to assess the long-term effects of blood pressure (BP) lowering (BPL) and lipid lowering on all-cause and cardiovascular mortality after discontinuation of randomized treatment. <br/><br/> METHODS: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials. We included large-scale randomized controlled trials of BPL or lipid lowering of at least 1 year with post-trial follow-up. We identified 13 BPL trials with 48 892 participants and 10 lipid-lowering trials with 71 370 participants. Mean in-trial and post-trial follow-up was approximately 4 and 6 years, respectively. <br/><br/>RESULTS: BP and lipid levels tended to come together soon in the post-trial period. There was significant benefit of BPL on all-cause mortality during the in-trial period (relative risk 0.85, 95% confidence interval 0.81-0.89), and significant, but attenuated, benefit during overall follow-up (0.91, 0.87-0.94). Likewise, lipid lowering with statins reduced the risk of all-cause mortality during the in-trial period (0.88, 0.81-0.95), and this effect persisted during overall follow-up (0.92, 0.87-0.97). Similar findings were observed for cardiovascular death. In BPL trials, the cumulative reduction in all-cause mortality was significantly lower in trials with at least 5 years of post-trial follow-up compared with those with less than 5 years, and a similar tendency was observed for lipid-lowering trials. <br/><br/>CONCLUSION: Benefits of BPL and lipid lowering on all-cause and cardiovascular mortality were persistent, but attenuated, after discontinuation of randomized treatment, indicating the importance of continuing therapy. |
| first_indexed | 2024-03-07T02:49:43Z |
| format | Journal article |
| id | oxford-uuid:ad3f97c1-8746-4654-88d8-56cb9a1fe967 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:49:43Z |
| publishDate | 2017 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:ad3f97c1-8746-4654-88d8-56cb9a1fe9672022-03-27T03:34:27ZCumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:ad3f97c1-8746-4654-88d8-56cb9a1fe967EnglishSymplectic Elements at OxfordLippincott, Williams & Wilkins2017Hirakawa, YArima, HRodgers, AWoodward, MChalmers, J OBJECTIVE: Persistent long-term benefits after discontinuation of treatment have been suggested for blood pressure-lowering and lipid-lowering treatment. We conducted a systematic review to assess the long-term effects of blood pressure (BP) lowering (BPL) and lipid lowering on all-cause and cardiovascular mortality after discontinuation of randomized treatment. <br/><br/> METHODS: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials. We included large-scale randomized controlled trials of BPL or lipid lowering of at least 1 year with post-trial follow-up. We identified 13 BPL trials with 48 892 participants and 10 lipid-lowering trials with 71 370 participants. Mean in-trial and post-trial follow-up was approximately 4 and 6 years, respectively. <br/><br/>RESULTS: BP and lipid levels tended to come together soon in the post-trial period. There was significant benefit of BPL on all-cause mortality during the in-trial period (relative risk 0.85, 95% confidence interval 0.81-0.89), and significant, but attenuated, benefit during overall follow-up (0.91, 0.87-0.94). Likewise, lipid lowering with statins reduced the risk of all-cause mortality during the in-trial period (0.88, 0.81-0.95), and this effect persisted during overall follow-up (0.92, 0.87-0.97). Similar findings were observed for cardiovascular death. In BPL trials, the cumulative reduction in all-cause mortality was significantly lower in trials with at least 5 years of post-trial follow-up compared with those with less than 5 years, and a similar tendency was observed for lipid-lowering trials. <br/><br/>CONCLUSION: Benefits of BPL and lipid lowering on all-cause and cardiovascular mortality were persistent, but attenuated, after discontinuation of randomized treatment, indicating the importance of continuing therapy. |
| spellingShingle | Hirakawa, Y Arima, H Rodgers, A Woodward, M Chalmers, J Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis. |
| title | Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis. |
| title_full | Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis. |
| title_fullStr | Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis. |
| title_full_unstemmed | Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis. |
| title_short | Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis. |
| title_sort | cumulative in trial and post trial effects of blood pressure and lipid lowering systematic review and meta analysis |
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