Carr, Matthew J and Bao, Yanchun and Pan, Jianxin and Cruickshank, Kennedy and McNamee, Roseanne (2012) The predictive ability of blood pressure in elderly trial patients. Journal of Hypertension, 30 (9). pp. 1725-1733. DOI https://doi.org/10.1097/hjh.0b013e3283568a73
Carr, Matthew J and Bao, Yanchun and Pan, Jianxin and Cruickshank, Kennedy and McNamee, Roseanne (2012) The predictive ability of blood pressure in elderly trial patients. Journal of Hypertension, 30 (9). pp. 1725-1733. DOI https://doi.org/10.1097/hjh.0b013e3283568a73
Carr, Matthew J and Bao, Yanchun and Pan, Jianxin and Cruickshank, Kennedy and McNamee, Roseanne (2012) The predictive ability of blood pressure in elderly trial patients. Journal of Hypertension, 30 (9). pp. 1725-1733. DOI https://doi.org/10.1097/hjh.0b013e3283568a73
Abstract
Objectives: To assess the impact of the blood pressure (BP) profile on cardiovascular risk in the Medical Research Council (UK) elderly trial; investigate whether the effects of hypertensive drugs in reducing event rates are solely a product of systolic pressure reduction. Methods: Using longitudinal BP data from 4396 hypertensive patients, the general trend over time was estimated using a first-stage multilevel model. We then investigated how BP acted alongside other BP-related covariates in a second-stage 'time-to-event' statistical model, assessing risk for stroke events and coronary heart disease (CHD). Differences in outcome prediction between diuretic, β-blocker and placebo treatment arms were investigated. Results: The β-blocker arm experienced comparatively poor control of current SBP, episodic peaks and variability in BP levels. After adjusting for the mean level, variability in SBP over time was significant: risk ratio was 1.15 [95% confidence interval (CI): 1.01-1.31] across all patients for stroke events. The risk ratio for current SBP was 1.36 (95% CI: 1.16-1.58). Current DBP and variability in DBP also predicted stroke independently: risk ratios was 1.43 and 1.18, respectively. The risk factors exhibited weaker associations with CHD risk; only the highest measured value and variability in SBP showed a statistically significant association: risk ratios were 1.26 and 1.16, respectively. CONCLUSION:: Individual risk characterization could be augmented with additional prognostic information, besides current SBP, including current diastolic pressure, temporal variability over and above general trends and historical measurements. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Item Type: | Article |
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Uncontrolled Keywords: | Humans; Hypertension; Antihypertensive Agents; Predictive Value of Tests; Blood Pressure; Aged; Female; Male; Clinical Trials as Topic |
Subjects: | H Social Sciences > HA Statistics R Medicine > R Medicine (General) |
Divisions: | Faculty of Science and Health Faculty of Science and Health > Mathematics, Statistics and Actuarial Science, School of |
SWORD Depositor: | Unnamed user with email elements@essex.ac.uk |
Depositing User: | Unnamed user with email elements@essex.ac.uk |
Date Deposited: | 04 Dec 2015 13:37 |
Last Modified: | 30 Oct 2024 09:13 |
URI: | http://repository.essex.ac.uk/id/eprint/15594 |