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Lack of a significant legacy effect of baseline blood pressure 'treatment naivety' on all-cause and cardiovascular mortality in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Ho, CLB, Breslin, M ORCID: 0000-0002-8135-3136, Chowdhury, EK, Doust, J, Reid, CM, Davis, BR, Simpson, LM and Nelson, MR ORCID: 0000-0001-9941-7161 2019 , 'Lack of a significant legacy effect of baseline blood pressure 'treatment naivety' on all-cause and cardiovascular mortality in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial' , Journal of Hypertension, vol. 37, no. 1 , pp. 1-8 , doi: 10.1097/HJH.0000000000002280.

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Abstract

Objectives: To investigate legacy effects at 14-year follow-up of all-cause and cardiovascular disease (CVD) mortality in 'treatment-naive' or 'previous treatment' groups based on blood pressure (BP)-lowering treatment status at baseline.Methods: A post-hoc observational study of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. We excluded participants with a previous history of CVD events. Cox proportional hazard model and 95% confidence interval were used to estimate the effects of treatment naive on mortality outcomes. Moreover, a subgroup analysis by estimated 10-year Framingham risk score was performed.Results: In multivariable models adjusting for baseline and in-trial characteristics (BP values and number of BP medications as time-dependent variables), there was no statistically significant difference in 5 and 14-year all-cause mortality with a hazard ratio of 0.93 (95% confidence interval 0.80-1.09) and hazard ratio 0.95 (0.88-1.03) and in 5 and 14-year CVD mortality hazard ratio 0.94 (0.72-1.23) and hazard ratio 0.93 (0.80-1.08). In subgroup by absolute CVD risk, no heterogeneity of the association between treatment naive and short-term or long-term all-cause or CVD mortality were found. All comparisons are between the treatment-naive and previous treatment groups.Conclusion: Physicians are concerned about 'legacy effects' of not treating individuals with a BP of 140 mmHg or over and low absolute risk. When treatment intensification was taken into consideration in the primary prevention population in this study, no adverse legacy effect as a result of baseline BP 'treatment naivety' was evident in 14 years of follow-up. The nonsignificant associations were consistent across the CVD risk subgroups. However, the results may be biased due to unobserved residual confounding and therefore should be interpreted with caution.

Item Type: Article
Authors/Creators:Ho, CLB and Breslin, M and Chowdhury, EK and Doust, J and Reid, CM and Davis, BR and Simpson, LM and Nelson, MR
Keywords: absolute cardiovascular risk, all-cause mortality, antihypertensive drug, cardiovascular disease, cardiovascular disease mortality, hypertension, primary prevention, blood pressure lowering drug therapy
Journal or Publication Title: Journal of Hypertension
Publisher: Lippincott Williams & Wilkins
ISSN: 0263-6352
DOI / ID Number: 10.1097/HJH.0000000000002280
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Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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