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Legacy effect of delayed blood pressure-lowering pharmacotherapy in middle-aged individuals stratified by absolute cardiovascular disease risk: Protocol for a systematic review


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Ho, CLB, Sanders, S, Doust, J, Breslin, M ORCID: 0000-0002-8135-3136, Reid, CM and Nelson, MR ORCID: 0000-0001-9941-7161 2017 , 'Legacy effect of delayed blood pressure-lowering pharmacotherapy in middle-aged individuals stratified by absolute cardiovascular disease risk: Protocol for a systematic review' , JMIR Research Protocols, vol. 6, no. 9 , pp. 1-7 , doi: 10.2196/resprot.8362.

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Background: Many national and international guidelines recommend that the initiation of blood pressure (BP)-lowering drug treatment for the primary prevention of cardiovascular disease (CVD) should no longer be based on BP level alone, but on absolute cardiovascular risk. While BP-lowering drug treatment is beneficial in high-risk individuals at any level of elevated BP, clinicians are concerned about legacy effects on patients with low-to-moderate risk and mildly elevated BP who remain "untreated".Objective: We aim to investigate the legacy effect of delayed BP-lowering pharmacotherapy in middle-aged individuals (45-65 years) with mildly elevated BP (systolic BP 140-159 mm Hg and/or diastolic BP 90-99 mm Hg) stratified by absolute risk for primary prevention of CVD, but particularly in the low-risk (Methods: Randomized trials of BP-lowering therapy versus placebo or pretreated subjects in active comparator studies with posttrial follow-up will be identified using a 2-step process. First, randomized trials of BP-lowering therapy will be identified by (1) retrieving the references of trials included in published systematic reviews of BP-lowering therapy, (2) retrieving studies published by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC), and (3) checking studies referenced in the 1993 World Health Organization/International Society of Hypertension meeting memorandum on BP management. Posttrial follow-up studies will then be identified by forward citation searching the randomized trials identified in step 1 through Web of Science. The search will include randomized controlled trials with at least 1-year in-trial period and a posttrial follow-up phase. Age is the major determinant of absolute cardiovascular risk, so the participants in our review will be restricted to middle-aged adults who are more likely to have a lower cardiovascular risk profile. The primary outcome will be all-cause mortality. Secondary outcomes will include cardiovascular mortality, fatal stroke, fatal myocardial infarction, and death due to heart failure.Results: The searches for existing systematic reviews and BPLTTC studies were piloted and modified. The study is expected to be completed before June 2018.Conclusions: The findings of this study will contribute to the body of knowledge concerning the beneficial, neutral, or harmful effects of delayed BP-lowering drug treatment on the primary prevention of CVD in patients with mildly elevated BP and low-to-moderate CVD risk.

Item Type: Article
Authors/Creators:Ho, CLB and Sanders, S and Doust, J and Breslin, M and Reid, CM and Nelson, MR
Keywords: cardiovascular disease, high blood pressure, legacy effect
Journal or Publication Title: JMIR Research Protocols
Publisher: JMIR Publications, Inc
ISSN: 1929-0748
DOI / ID Number: 10.2196/resprot.8362
Copyright Information:

Copyright 2017 the Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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