Risk and decision making in patients with hypertension

摘要

In The Lancet, the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) report an individual patient data meta-analysis of trials that randomly assigned patients to blood pressure-lowering drugs or placebo, or more intensive or less intensive blood pressure-lowering strategies.1 The expected, albeit important, conclusion of the study is that blood pressure-lowering drugs provide a similar relative benefit across different strata of predicted cardiovascular risk: in an analysis of 51917 participants in 11 trials, blood pressure-lowering treatment reduced the relative risk of events in patients in four groups of increasing estimated baseline cardiovascular risk by 18% (95% Cl 7-27), 15% (4-25), 13% (2-22), and 15% (5-24),' respectively. Hence, by definition, the absolute benefit of treatment would increase with the baseline risk, and treatment of 1000 patients in each group for 5 years should prevent 14 (95% Cl 8-21), 20 (8-31), 24 (8-40), and 38 (16-61) cardiovascular events, respectively. The number-needed-to-treat to prevent an event would decrease accordingly.