Document Detail

Blood pressure reduction and cardiovascular prevention: meta-regression using ordered categorical (ordinal) event data.
MedLine Citation:
PMID:  20577120     Owner:  NLM     Status:  MEDLINE    
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.
Chamila M Geeganage; Michael Tracy; Matthew W Bath; Philip M W Bath
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of hypertension     Volume:  28     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-16     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  1995-9     Citation Subset:  IM    
Stroke Trials Unit, Institute of Neuroscience, University of Nottingham, Nottingham, UK.
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MeSH Terms
Aged, 80 and over
Antihypertensive Agents / pharmacology,  therapeutic use
Blood Pressure / drug effects,  physiology
Cardiovascular Diseases / prevention & control*
Hypertension / complications*,  drug therapy*
Middle Aged
Myocardial Infarction / prevention & control
Randomized Controlled Trials as Topic
Regression Analysis
Severity of Illness Index
Stroke / prevention & control
Young Adult
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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