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Blood pressure reduction and cardiovascular prevention: meta-regression using ordered categorical (ordinal) event data.

Abstract：

BACKGROUND:Blood pressure (BP)-lowering trials studying efficacy mostly assesses binary outcome events, for example stroke/no stroke. Analysis of ordered categorical vascular events (e.g. three levels: fatal stroke/nonfatal stroke/no stroke) provides information on severity and is more powerful statistically than analyses using binary data, as used in previous meta-regression analyses of BP lowering. METHODS:Summary data on stroke, myocardial infarction, and combined vascular events were obtained from published BP-lowering trials. Ordinal and binary odds ratios were calculated. The relationship between the difference in BP and treatment odds ratio was assessed using meta-regression. RESULTS:Thirty-eight trials involving 180 804 patients were included. A 'U' or 'J'-shaped relationship was found between on-treatment BP difference and three level ordinal stroke, ordinal myocardial infarction, and ordinal combined vascular outcome. Similar relationships were noted for binary stroke, myocardial infarction, and combined vascular outcome. Meta-regression curves for three level ordinal analyses were similar in shape and position to that for binary analyses. CONCLUSIONS:Meta-regression using ordinal outcomes in hypertension trials is practical and gives comparable values for the odds ratio as found in analyses based on binary outcomes. However, trials and meta-analyses reporting ordinal outcomes provide additional information in particular that lowering BP reduces both the severity and frequency of fatal and recurrent stroke. Trials should report data so that ordinal analyses may be performed.

journal_name

J Hypertens

journal_title

Journal of hypertension

authors

Geeganage CM,Tracy M,Bath MW,Bath PM

doi

10.1097/HJH.0b013e32833c7a32

subject

Has Abstract

pub_date

2010-10-01 00:00:00

pages

1995-9

issue

10

eissn

0263-6352

issn

1473-5598

journal_volume

28

pub_type

杂志文章

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