Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean: a systematic review of randomized trials.


OBJECTIVE:To assess the clinical relevance of regression to the mean for clinical trials and clinical practice. METHODS:MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. RESULTS:Eighty-six trials (349 488 participants), with mean follow-up of 3.7 years, were included. Most mean BP change was because of regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14% (95% CI 11-17%) and stroke by 18% (15-22%), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the SBP 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP less than 140 mmHg. CONCLUSION:Clinical practice should focus less on pretreatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.


J Hypertens


Journal of hypertension


Salam A,Atkins E,Sundström J,Hirakawa Y,Ettehad D,Emdin C,Neal B,Woodward M,Chalmers J,Berge E,Yusuf S,Rahimi K,Rodgers A,Blood Pressure Lowering Treatment Trialists’ Collaboration.




Has Abstract


2019-01-01 00:00:00














  • Determinants of blood pressure treatment and control in obese people: evidence from the general population.

    abstract:OBJECTIVE:We assessed hypertension prevalence, blood pressure (BP)-lowering treatment and control in obese adults compared with lean/normal-weight individuals in France. METHODS:Multistage stratified random sample of 2075 adults from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carr...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Czernichow S,Castetbon K,Salanave B,Vernay M,Barry Y,Batty GD,Hercberg S,Blacher J

    更新日期:2012-12-01 00:00:00

  • Neurocognition in treatment-resistant hypertension: profile and associations with cardiovascular biomarkers.

    abstract:BACKGROUND:Hypertension in midlife has been associated with increased risk of stroke and neurocognitive decline. Few studies, however, have examined neurocognition among individuals with treatment-resistant hypertension or potential mechanisms by which treatment-resistant hypertension may impair neurocognition. METHOD...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Smith PJ,Blumenthal JA,Hinderliter AL,Mabe SM,Schwartz JE,Avorgbedor F,Sherwood A

    更新日期:2019-05-01 00:00:00

  • The interplay between haemodynamic load, brain natriuretic peptide and left atrial size in the early stages of essential hypertension.

    abstract:OBJECTIVE:Left atrial (LA) enlargement is an index of adverse cardiovascular events. We sought to investigate any possible correlation between haemodynamic load, neurohumoral factors and LA size in the early stages of essential hypertension. METHODS:We studied 94 consecutive middle-aged subjects, with newly diagnosed ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Tsioufis C,Stougiannos P,Taxiarchou E,Skiadas I,Chatzis D,Thomopoulos C,Lalos S,Stefanadis C,Kallikazaros I

    更新日期:2006-05-01 00:00:00

  • Bradykinin metabolism in the isolated perfused rabbit heart.

    abstract:BACKGROUND:Bradykinin is a potent cardioprotective hormone, the beneficial role of which in vivo appears to be limited by its rapid metabolism. Inhibitors of peptidases that degrade endogenously formed bradykinin are themselves cardioprotective, presumably by increasing local bradykinin concentrations. As bradykinin-de...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Taylor-McCabe KJ,Erşahin C,Simmons WH

    更新日期:2001-07-01 00:00:00

  • Peak growth velocity in infancy is positively associated with blood pressure in school-aged children.

    abstract:OBJECTIVES:Rapid growth velocity in early life may be a risk factor for obesity, elevated blood pressure, and adverse metabolic markers in childhood, but results are not consistent. We analysed the association between peak growth velocity during the first 2 years of life and blood pressure, fasting glucose and insulin ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Thiering E,Brüske I,Kratzsch J,Hoffmann B,Herbarth O,von Berg A,Schaaf B,Wichmann HE,Heinrich J,LISAplus Study Group.

    更新日期:2012-06-01 00:00:00

  • Kinetic properties of erythrocyte Na+-Li+ and Na+-H+ exchange in hypertensive patients.

    abstract:OBJECTIVE:To ascertain the relationships between the kinetic properties of erythrocyte Na+-H+ exchange [maximum kinetic energy (Vmax), Michaelis constant (Km) for internal H+ and Hill's coefficient], Na+-Li+ (Vmax and Km for external Na+), and metabolic parameters in normotensive controls and hypertensive subjects. MA...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Semplicini A,Ceolotto G,Felice M,Reato S,Valle R,Gebbin A,Fontebasso A,Serena L,Pessina AC

    更新日期:1995-12-01 00:00:00

  • Alterations of cardiac contractile function are related to changes in membrane calcium transport in spontaneously hypertensive rats.

    abstract:OBJECTIVE:Transport activities of cardiac sodium-calcium exchange and sarcoplasmic reticulum calcium ATPase were measured biochemically in spontaneously hypertensive rats (SHR) with hypertrophied myocardium and in normotensive Wistar-Kyoto (WKY) rats and it was tested whether possible differences have consequences for ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Lammerich A,Günther J,Pfitzer G,Storch E,Vetter R

    更新日期:1995-11-01 00:00:00

  • Automated blood pressure measurement in atrial fibrillation: validation process modification and evaluation of a novel professional device which detects atrial fibrillation and adapts its blood pressure measurement algorithm.

    abstract:OBJECTIVES:Blood pressure (BP) measurement in atrial fibrillation (AF) patients is problematic and automated monitors are regarded as inaccurate. The optimal procedure for validating BP monitors in AF is questionable. This study evaluated the accuracy of a novel professional oscillometric upper-arm cuff device (Microli...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Stergiou GS,Kyriakoulis KG,Bountzona I,Menti A,Destounis A,Kalogeropoulos P,Kollias A

    更新日期:2020-10-16 00:00:00

  • Influence of exercise at lower and higher intensity on blood pressure and cardiovascular risk factors at older age.

    abstract:OBJECTIVE:It is not well known which exercise intensity is needed to obtain blood pressure reductions in response to endurance training. We therefore compared the effect of training at lower and higher intensity on blood pressure, and, in addition on other cardiovascular risk factors, in at least 55-year-old sedentary ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章,随机对照试验


    authors: Cornelissen VA,Arnout J,Holvoet P,Fagard RH

    更新日期:2009-04-01 00:00:00

  • The effect of patient 'familiarity' with blood pressure assessment on the accuracy of follow-up readings.

    abstract::The fall in blood pressure that is commonly observed when groups of hypertensive individuals are followed without treatment is usually ascribed to two sources: regression towards the mean and increasing familiarity of the subject with the assessment process. Any effect of the latter process could bias the results of c...

    journal_title:Journal of hypertension

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Haynes RB,Logan AG,Flanagan PT,Milne BJ

    更新日期:1983-06-01 00:00:00

  • Left-versus-right-adrenal-volume ratio as a screening index before adrenal venous sampling to identify unilateral primary aldosteronism patients.

    abstract:OBJECTIVES:The current study aimed to investigate the value of the computed tomography-based left-versus-right adrenal gland volume ratio (L/Rv) in screening patients with unilateral primary aldosteronism. METHODS:The current study recruited 114 patients who underwent successful adrenal venous sampling (AVS) and adren...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Li S,Sun H,Ma L,Zhu Y,Xie W,Sun J,Zhao L,Qing B,Ren Y,Tian H,Chen T

    更新日期:2020-02-01 00:00:00

  • Coagulation factor XIIa-kinin-mediated contribution to hypertension of chronic kidney disease.

    abstract:BACKGROUND:Activated coagulation Factor XII (FXIIa) infusion increases peripheral resistance (TPR) and mean arterial pressure (MAP) of Brown Norway but not plasma kininogen deficient Brown Norway Katholiek (BNK) rats. FXIIa concentrations are elevated in hypertensive end-stage renal disease patients receiving conventio...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Papageorgiou PC,Chan CT,Yeo EL,Backx PH,Floras JS

    更新日期:2014-07-01 00:00:00

  • Is it time to measure microalbuminuria in hypertension?

    abstract::Former guidelines on hypertension never made a commitment to the detection of microalbuminuria for screening or follow-up of hypertensive patients. On the other hand, growing evidence support the contributory role of microalbuminuria in the prediction of absolute cardiovascular risk in hypertension and document the po...

    journal_title:Journal of hypertension

    pub_type: 杂志文章,评审


    authors: Volpe M,Cosentino F,Ruilope LM

    更新日期:2003-07-01 00:00:00

  • Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?

    abstract:OBJECTIVE:To determine whether the decision to treat uncomplicated mild hypertension with drugs, in accordance with the World Health Organization - International Society of Hypertension (WHO/ISH) guidelines based on a series of blood pressure (BP) measurements over 6 months, resulted in the treatment of patients at hig...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Abergel E,Chatellier G,Battaglia C,Menard J

    更新日期:1999-06-01 00:00:00

  • Characterization of the antihypertensive effect of a thiazide diuretic in angiotensin II-induced hypertension.

    abstract:OBJECTIVES:The antihypertensive effect of thiazide diuretics in angiotensin II induced hypertension has never been characterized. In the current study, we sought to determine the effect of a thiazide diuretic on arterial pressure and renal fluid excretion in rats receiving a chronic intravenous infusion of angiotensin ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Ballew JR,Fink GD

    更新日期:2001-09-01 00:00:00

  • Hypertension in Diabetes Study (HDS): II. Increased risk of cardiovascular complications in hypertensive type 2 diabetic patients.

    abstract:OBJECTIVE:To determine the degree to which hypertension is a risk factor for macrovascular and microvascular complications in type 2 diabetes. DESIGN:Observational prospective study. SUBJECTS:Newly diagnosed Type 2 diabetic patients recruited into the UK Prospective Diabetes Study (n = 3648; mean age 52 years), 40% o...

    journal_title:Journal of hypertension

    pub_type: 杂志文章



    更新日期:1993-03-01 00:00:00

  • Characteristics of the 24-h ambulatory blood pressure monitoring in patients with Parkinson's disease - the SFC BP multicentre study in China.

    abstract:OBJECTIVES:Cardiovascular dysautonomia can be present at early, late and even prodromal stages of Parkinson's disease. This study aimed to describe the characteristics of 24-h ambulatory blood pressure (BP) monitoring and investigate the frequency of cardiovascular dysautonomia in Parkinson's disease without an abnorma...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Chen SW,Wang YK,Dou RH,Xie XY,Hu YB,Ding N,Zhang GH,Jing HF,Zhao WD,Xue Y,Li Y,Wang G

    更新日期:2020-11-01 00:00:00

  • Arterial hypertension and cerebral hemodynamics: impact of head-down tilt on cerebral blood flow (arterial spin-labeling-MRI) in healthy and hypertensive patients.

    abstract:OBJECTIVE:Hypertension affects cerebrovascular autoregulation and increases the risk of cerebrovascular events and dementia. Notably, it is associated with cerebrovascular remodeling and lower resting cerebral blood flow (CBF). We wanted to determine, using arterial spin-labeling-MRI, the impact of a head-down tilt (HD...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Seiller I,Pavilla A,Ognard J,Ozier-Lafontaine N,Colombani S,Cepeda Ibarra Y,Mejdoubi M

    更新日期:2020-12-09 00:00:00

  • Hormone replacement improves hemodynamic profile and left ventricular geometry in hypertensive and normotensive postmenopausal women.

    abstract:BACKGROUND:Postmenopausal estrogen replacement, with or without progestins, has been related to lower cardiovascular risks. OBJECTIVE:We investigated whether the actions of estrogen on vascular resistance contribute to this cardioprotective effect. DESIGN AND METHODS:In a 6-month double-blind study, pre- and post-tre...

    journal_title:Journal of hypertension

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Light KC,Hinderliter AL,West SG,Grewen KM,Steege JF,Sherwood A,Girdler SS

    更新日期:2001-02-01 00:00:00

  • Dietary starch intake of individuals and their blood pressure: the International Study of Macronutrients and Micronutrients and Blood Pressure.

    abstract:OBJECTIVE:Data from the Multiple Risk Factor Intervention Trial show an independent direct association between starch intake and blood pressure in American men at higher risk of coronary heart disease. Cross-sectional data from the International Study of Macronutrients and Micronutrients and Blood Pressure (INTERMAP) w...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Brown IJ,Elliott P,Robertson CE,Chan Q,Daviglus ML,Dyer AR,Huang CC,Rodriguez BL,Sakata K,Ueshima H,Van Horn L,Zhao L,Stamler J,INTERMAP Research Group.

    更新日期:2009-02-01 00:00:00

  • Atrial natriuretic peptide behaviour and myocyte hypertrophic profile in combined pressure and volume-induced cardiac hypertrophy.

    abstract:OBJECTIVE:To investigate cardiomyocyte hypertrophy and hormonal profile in cardiac hypertrophy resulting from sequentially applied overloads. METHODS:We studied Sprague-Dawley rats with renovascular hypertension (RV), where pressure overload predominates, or deoxycorticosterone acetate (DOCA)-salt (DS), where volume o...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Cavallero S,González GE,Puyó AM,Rosón MI,Pérez S,Morales C,Hertig CM,Gelpi RJ,Fernández BE

    更新日期:2007-09-01 00:00:00

  • Isolation of T-cell clones with specificity for arterial antigen from spontaneously hypertensive rats.

    abstract:OBJECTIVE:It has been postulated that hypertension in the spontaneously hypertensive rat (SHR) results from autoimmune damage to the SHR vasculature. The objective of this study was to isolate autoreactive T-cells specific for arterial antigens, and to characterize these cells. DESIGN:The presence of autoreactive T-ce...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Ofosu-Appiah W,Ruggiero C,Huang LY

    更新日期:1993-12-01 00:00:00

  • Obesity, alcohol consumption and blood pressure in Australian men and women. The National Heart Foundation of Australia Risk Factor Prevalence Study.

    abstract::The associations of obesity and alcohol consumption with blood pressure and the prevalence of hypertension were studied in 5550 male and female subjects aged 25 to 64 years, surveyed in the National Heart Foundation of Australia 1980 Risk Factor Prevalence Study. Body mass index was significantly and independently ass...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: MacMahon SW,Blacket RB,Macdonald GJ,Hall W

    更新日期:1984-02-01 00:00:00

  • Angiotensinogen T174M and M235T variants, sodium intake and hypertension among non-drinking, lean Japanese men and women.

    abstract:OBJECTIVE:To examine the interaction of sodium intake with genetic variations of the angiotensinogen gene and hypertension. DESIGN:A community-based case-reference study. SETTING:Two rural Japanese communities. PARTICIPANTS:Non-overweight and non-drinking Japanese men and women: 229 hypertensives and 229 age-, sex- ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Iso H,Harada S,Shimamoto T,Sato S,Kitamura A,Sankai T,Tanigawa T,Iida M,Komachi Y

    更新日期:2000-09-01 00:00:00

  • Congenital defects and early childhood outcomes following in-utero exposure to antihypertensive medication.

    abstract:BACKGROUND:Hypertensive disorders during pregnancy are an important risk to mother and fetus, frequently necessitating antihypertensive treatment. Data describing the safety of in-utero exposure to antihypertensive treatment is conflicting with many studies suffering from significant methodological issues. METHOD:We c...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Fitton CA,Fleming M,Aucott L,Pell JP,Mackay DF,McLay JS

    更新日期:2020-10-09 00:00:00

  • Race and gender influence hemodynamic responses to psychological and physical stimuli.

    abstract::To evaluate factors influencing hemodynamic responses to psychological and physical stress, 117 normotensive college students were studied. The standardized tests included arithmetic, Stroop word-color, mirror draw, isometric handgrip and cold pressor challenges. The responses of blood pressure and pulse during the te...

    journal_title:Journal of hypertension

    pub_type: 临床试验,杂志文章


    authors: McAdoo WG,Weinberger MH,Miller JZ,Fineberg NS,Grim CE

    更新日期:1990-10-01 00:00:00

  • Noninvasive assessment of carotid-femoral pulse wave velocity: the influence of body side and body contours.

    abstract:BACKGROUND:Recently, an expert group advised to measure carotid-femoral (cf) pulse wave velocity (PWV) on the right side of the body, and to use a sliding caliper when tape measure distance cannot be obtained in a straight line. The present study investigates the evidence for this advice by comparing the real travelled...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Bossuyt J,Van De Velde S,Azermai M,Vermeersch SJ,De Backer TL,Devos DG,Heyse C,Filipovsky J,Segers P,Van Bortel LM

    更新日期:2013-05-01 00:00:00

  • Hypertension susceptibility genes on chromosome 2p24-p25 in a general Japanese population.

    abstract:BACKGROUND:Genome-wide scans from Italy and China suggest a hypertension-susceptible locus between D2S2278 (nucleotides 11,245,080 - 11,245,358) and D2S168 (nucleotides 11,467,214 - 11,467,422) on chromosome 2. METHODS:We performed a large association study of polymorphisms in this region with blood pressure modulatio...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Kamide K,Kokubo Y,Yang J,Tanaka C,Hanada H,Takiuchi S,Inamoto N,Banno M,Kawano Y,Okayama A,Tomoike H,Miyata T

    更新日期:2005-05-01 00:00:00

  • Microalbuminuria, renal function and development of sustained hypertension: a longitudinal study in the early stage of hypertension.

    abstract:OBJECTIVE:Microalbuminuria (MA) is a marker of adverse outcome in hypertension. The aim of this study was to investigate the association of MA with cardiovascular risk factors and glomerular hyperfiltration in the early stage of hypertension and to assess its predictive value for the development of sustained hypertensi...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Palatini P,Mormino P,Mos L,Mazzer A,Dorigatti F,Zanata G,Longo D,Garbelotto R,De Toni R,Graniero G,Pessina AC,HARVEST Study Group.

    更新日期:2005-01-01 00:00:00

  • Predictors for profound blood pressure response in patients undergoing renal sympathetic denervation.

    abstract:BACKGROUND:Renal sympathetic denervation (RDN) as treatment for hypertension shows highly variable results. Although some patients do not show any blood pressure (BP) change and in most patients a BP reduction of at least 5 mmHg can be found, some show a reduction at least 20 mmHg. We sought to identify predictors for ...

    journal_title:Journal of hypertension

    pub_type: 杂志文章


    authors: Fengler K,Rommel KP,Blazek S,von Roeder M,Besler C,Hartung P,Desch S,Thiele H,Lurz P

    更新日期:2018-07-01 00:00:00