title: Importance of sustained and "tight" blood pressure control in patients with high cardiovascular risk.
abstract: A retrospective further analysis of the ACTION database evaluated the relationship between cardiovascular outcomes and the "quality" of the control of blood pressure (BP). The study population (n = 6287) comprised those patients with four BP measurements during year 1 subdivided according to the proportion of visits in which BP was controlled in relation to two BP targets: < 140/90mmHg and < 130/80 mmHg. Differences between the BP control groups for the major prespecified ACTION outcomes were investigated with Cox proportional hazards models. For all the prespecified cardiovascular endpoints the incidence declined as the proportion of visits with BP control increased. The greatest differences in outcomes between the different BP control groups were observed for the risk of stroke but were still apparent for all the other endpoints. For example, the risks for the primary outcome [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.67 to 0.90] were significantly less in the group with >_75% of visits with BP control than in the group with < 25% of visits with BP control. There were no significant treatment-related differences. Retrospective analyses are not definitive but these results highlight the importance of the attainment of BP control targets and the consistency of BP control during long-term follow-up.
authors.affiliation: a Division of Cardiovascular and Medical Sciences , University of Glasgow , Western Infirmary , Glasgow , UK ;
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meredith
authors.affiliation: b Robertson Centre for Biostatistics, University of Glasgow , Glasgow , UK ;
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Lloyd
authors.affiliation: b Robertson Centre for Biostatistics, University of Glasgow , Glasgow , UK ;
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.affiliation: c Institute of Pharmaceutical and Biomedical Sciences, University of Strathclyde , Glasgow , UK.
authors.forename: Henry L
authors.initials: HL
authors.lastname: Elliott
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016208:Databases, Factual; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D009543:Nifedipine / Q000627:therapeutic use*; D009819:Office Visits / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013599:Systole; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D009543:Nifedipine
keywords: ACTION trial; blood pressure; nifedipine GITS; retrospective study; stable angina