Monitoring Initial Response to Angiotensin-Converting Enzyme Inhibitor–Based Regimens: An Individual Patient Data Meta-Analysis From Randomized, Placebo-Controlled Trials.
Access status:
Open Access
Type
ArticleAuthor/s
Bell, Katy J.L.Hayen, Andrew
Macaskill, Petra
Craig, Jonathan C
Neal, Bruce
Fox, Kim M
Remme, Willem J
Asselbergs, Folkert W
Van Gilst, Wiek H
MacMahon, Stephen
Remuzzi, Giuseppe
Ruggenenti, Piero
Teo, Koon K
Irwig, Les
Abstract
Most clinicians monitor blood pressure to estimate a patient’s response to blood pressure–lowering therapy. However, the apparent change may not actually reflect the effect of the treatment, because a person’s blood pressure varies considerably even without the administration of ...
See moreMost clinicians monitor blood pressure to estimate a patient’s response to blood pressure–lowering therapy. However, the apparent change may not actually reflect the effect of the treatment, because a person’s blood pressure varies considerably even without the administration of drug therapy. We estimated random background within-person variation, apparent between-person variation, and true between-person variation in blood pressure response to angiotensin-converting enzyme inhibitors after 3 months. We used meta-analytic mixed models to analyze individual patient data from 28 281 participants in 7 randomized, controlled trials from the Blood Pressure Lowering Trialists Collaboration. The apparent between-person variation in response was large, with SDs for change in systolic blood pressure/diastolic blood pressure of 15.2/8.5 mm Hg. Within-person variation was also large, with SDs for change in systolic blood pressure/diastolic blood pressure of 14.9/8.45 mm Hg. The true between-person variation in response was small, with SDs for change in systolic blood pressure/diastolic blood pressure of 2.6/1.0 mm Hg. The proportion of the apparent between-person variation in response that was attributed to true between-person variation was only 3% for systolic blood pressure and 1% for diastolic blood pressure. In conclusion, most of the apparent variation in response is not because of true variation but is a consequence of background within-person fluctuation in day-to-day blood pressure levels. Instead of monitoring an individual’s blood pressure response, a better approach may be to simply assume the mean treatment effect.
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See moreMost clinicians monitor blood pressure to estimate a patient’s response to blood pressure–lowering therapy. However, the apparent change may not actually reflect the effect of the treatment, because a person’s blood pressure varies considerably even without the administration of drug therapy. We estimated random background within-person variation, apparent between-person variation, and true between-person variation in blood pressure response to angiotensin-converting enzyme inhibitors after 3 months. We used meta-analytic mixed models to analyze individual patient data from 28 281 participants in 7 randomized, controlled trials from the Blood Pressure Lowering Trialists Collaboration. The apparent between-person variation in response was large, with SDs for change in systolic blood pressure/diastolic blood pressure of 15.2/8.5 mm Hg. Within-person variation was also large, with SDs for change in systolic blood pressure/diastolic blood pressure of 14.9/8.45 mm Hg. The true between-person variation in response was small, with SDs for change in systolic blood pressure/diastolic blood pressure of 2.6/1.0 mm Hg. The proportion of the apparent between-person variation in response that was attributed to true between-person variation was only 3% for systolic blood pressure and 1% for diastolic blood pressure. In conclusion, most of the apparent variation in response is not because of true variation but is a consequence of background within-person fluctuation in day-to-day blood pressure levels. Instead of monitoring an individual’s blood pressure response, a better approach may be to simply assume the mean treatment effect.
See less
Date
2010Source title
HypertensionVolume
56Issue
3Publisher
Publishing House ZaslavskyFunding information
NHMRC 457212
NHMRC 402764
NHMRC 358395
Servier
Health Research Council of New Zealand
Dutch Kidney Foundation
The Netherlands Heart Foundation
Bristol-Myers Squibb
Hoechst AG
Abbott GmbH & Co
Medical Research Council of Canada
Merck Frosst Canada Inc
Licence
Creative Commons Attribution 4.0Faculty/School
Faculty of Medicine and Health, Sydney School of Public HealthShare