Document Detail

Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens: an individual patient data meta-analysis from randomized, placebo-controlled trials.
MedLine Citation:
PMID:  20625081     Owner:  NLM     Status:  MEDLINE    
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 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.
Katy J L Bell; Andrew Hayen; Petra Macaskill; Jonathan C Craig; Bruce C Neal; Kim M Fox; Willem J Remme; Folkert W Asselbergs; Wiek H van Gilst; Stephen Macmahon; Giuseppe Remuzzi; Piero Ruggenenti; Koon K Teo; Les Irwig
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't     Date:  2010-07-12
Journal Detail:
Title:  Hypertension     Volume:  56     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-19     Completed Date:  2010-09-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  533-9     Citation Subset:  IM    
Screening and Test Evaluation Program, School of Public Health, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Antihypertensive Agents / therapeutic use
Blood Pressure / drug effects*
Hypertension / drug therapy*
Randomized Controlled Trials as Topic
Reproducibility of Results
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents

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

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